FAQs on Stellate Ganglion Block in Colorado

 

A stellate ganglion block is used to diagnose and/or treat neuropathic pain of the upper body region. The block is performed as an outpatient procedure, and you go home afterwards. This procedure involves administering an anesthetic or neurolytic agent, which blocks the transmission of pain and sympathetic nerve signals from the stellate ganglion to the brain.

What is the stellate ganglion?

The stellate ganglion is a bundle of nerves formed by the fusion of the inferior cervical (neck) and first thoracic (mid-back) ganglion as they meet at the 7th cervical vertebra. It lies in front of the prevertebral fasci tissue, and is near the phrenic nerve.

What conditions are treated with the stellate ganglion block?

This block is used to treat:

  • Complex regional pain syndrome
  • Sympathetically-mediated neuropathic pain
  • Causalgia (nerve injury
  • Reflex sympathetic dystrophy
  • Phantom limb pain
  • Herpectic neuralgia (herpes zoster or shingles)
  • Raynaud’s syndrome pain

How is the stellate ganglion block performed?

There are several ways to perform the stellate ganglion block. These include:

  • Level of 6th cervical vertebra – This involves injecting 15-20 ml of an anesthetic or neurolytic agent near the superficial nerves. It will spread downward to reach the stellate and upper thoracic ganglia.
  • At the 7th cervical vertebra – This involves administering around 5-10 ml of an anesthetic or neurolytic agent at the level of the 7th cervical vertebra.
  • Posterior paravertebral approach – The needle is inserted from the back near the upper thoracic lamina portion of the vertebra.

What can I expect during the procedure?

You will be given a sedative (twilight anesthesia), so you probably will not be alert during the procedure. After your skin is cleaned and numbed, the doctor moves your neck slightly, rotating your head to the opposite side. After retracting the muscle, the doctor inserts the needle under x-ray guidance to assure the needle is place near the nerves. After the solution is instilled, the needle is removed.

How will I know if the stellate ganglion block works?

A successful block will bring immediate pain relief and improve vascular flow to the upper extremity affected. After the local anesthetic wars off, you may have some soreness at the injection site. Expect to have some mild side effects, such as drooping of the eyelid, decreased sweating, and eye redness. This wears off in around 3-6 hours.

What are the benefits of the stellate ganglion block procedure?

The block is a minimally-invasive procedure that works well for people who do not respond to conventional medical management. In addition, it provides pain relief to the upper extremity, face, and chest affected by the disorder. When the block is done, one of three things will occur:

  1. Your pain will go away or be improved, remaining suppressed long after the anesthetic wears off. This alerts the doctor that the block has therapeutic value for you.
  2. Your pain will be unchanged, but the block had some sympathetic effects. This offers diagnostic value to the doctor.
  3. The block did not work at all, indicating that the pain was not of a sympathetic nervous system issue.

Does the stellate ganglion block work?

In a recent study, the stellate ganglion block was found to offer pain relief and improved sleep for patients with breast cancer pain. In addition, the block was fund to improve quality of life. A recent study involving this block for RSD found a 76% efficacy rate.

Resources

Ackerman WE & Zhang JM (2010). Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome. Southern Medical Assoc.

Gofeld M, Bhatia A, Abbas S, Ganapathy S, & Johnson M (2009). Development and validation of a new technique for ultrasound-guided stellate ganglion block. Reg Anesth Pain Med, 34(5):475-9.

Lipov EG, Joshi JR, Sanders S, et al. (2009). A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Med Hypotheses, 72(6):657-61.