Stellate Ganglion Block

A stellate ganglion block is an injection of local anesthetic into or around the stellate ganglion (sympathetic nerve ganglion). The stellate ganglion is a bundle of nerves located in the neck between your jaw and collar bone. Stellate ganglion block is a short, minimally invasive procedure that can effectively treat a wide array of conditions that have failed optimal medical management. These include providing relief for sympathetic-related pain in face, chest, and upper extremities, improving circulation in upper extremities and face, decreasing perspiration in upper extremities and face, decreasing hot flashes and associated sleep disturbances, and showing promise as a novel treatment for CRPS.

Please arrive 20 minutes prior to your appointment on procedure day. Our nurses will start an IV if you are requesting sedation and take a pre-operative nurse assessment. All patients are taken to the procedure room on a hospital bed. Once in the procedure room you will be given sedation to help make you comfortable. A cold cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Typically this is done in your neck on the painfully affected side. Once the site is identified a shot of numbing medicine (typically bupivicaine) will be given to numb up the skin. This may feel like a bee sting, but will only last a few seconds. The spinal needle is then placed into the position using x-ray guidance. Dye is injected to confirm proper placement of the needle and spread of medication around the stellate ganglion. Medication consisting of steroid (methylprednisilone) and local anesthetics (bupivicaine) is injected through the needle. This medication spreads around and bathes the nerves. Most patients report some pain relief almost immediately. The needle is then removed and you will be taken to the recovery room. The procedure itself takes 10-15 minutes and then you will be observed for another 15 minutes after the procedure. You may then go home and enjoy the rest of your day.

You may notice an immediate “warm sensation” in your arm or hand. You should also notice that your pain is substantially less and that you can move your arm/hand with less pain than prior to the injection. We tell most patients to take it easy the rest of the day, but you may return to normal activities as soon as you feel ready. The pain relief may last several days to several months. Some patients require repeat injections for long term pain relief. This procedure is repeated as above and is very safe and effective. Physical therapy is often prescribed immediately after the procedure in order to help restore function and range of motion to the affected side. Coordination with physical therapy is essential and should be done while you are still experience pain relief from the procedure itself.

Risks

Stellate ganglion blocks are considered an appropriate non surgical treatment for many patients who suffer from this type of pain. The procedure itself is very safe and has been performed for decades. The risks are typically low, but can include misplacement of the needle, bleeding, infection, pneumothorax (collapsed lung), puncture of surrounding organs, puncture of adjacent vessels, drug allergy, nerve damage and/or paralysis. These are exceedingly rare.