Stellate Ganglion Block
The stellate ganglion, a collection of nerves present on either side of the neck, is part of the sympathetic nervous system that is responsible for supplying the upper limbs, head, neck, and upper chest. These nerves are not involved with feeling or movement but damage to the nerves by trauma, infection, or disease conditions can lead to chronic pain. Transmission of nerve impulses across the stellate ganglion may be blocked by an injection usually containing an anesthetic to relieve painful symptoms and improve function.
The sympathetic nervous system is responsible for several involuntary processes such as blood pressure and temperature regulation as well as transmission of pain from neuropathic, vascular, and visceral sources. Patients who are candidates for this procedure usually suffer from a type of neuropathic pain called complex regional pain or reflex sympathetic dystrophy in the upper extremities and sometimes the head and neck. A stellate ganglion block can help diagnose and treat this condition. It can also help manage pain in conditions such as herpes zoster, persistent angina, and vascular disorders of the upper extremities as well as help increase circulation and blood supply to the arm. If the block is effective at relieving your pain, you will be recommended for a series of injections. The duration of relief increases with each injection.
The procedure is carried out under local anesthesia and sedation. You are transported to the procedure room where you will lie down on an x-ray table with your chin slightly raised. The skin of the neck is cleansed and draped in a sterile fashion. The target site is identified using anatomical landmarks and numbed with a local anesthetic. Fluoroscopy or live X-ray imaging is then used to guide a needle precisely to the stellate ganglion. Contrast dye may first be administered to confirm placement. The medication is then slowly injected. Once the procedure is complete, you will go to the recovery area and may be free to leave after a period of monitoring.
After the procedure, you may feel some warmth in the arm and a lump in your throat along with some hoarseness. You may also develop nasal congestion and eye redness on the treated side and sometimes a headache may occur. These symptoms usually last a few hours. You should have someone drive you home following the procedure. Rest is advised for the remainder of the day and you should be able to return to work the following day.
Risks and complications
A common complication of the procedure is temporary pain at the injection site. Other complications such as infection, bleeding and nerve damage are rare. Stellate ganglion blocks are not indicated for those who have had a recent heart attack or those receiving anticoagulant therapy.
A stellate ganglion block can provide relief from different kinds of pain mediated by the sympathetic nervous system. For some, pain relief lasts just a few hours while others experience prolonged relief for days or weeks. Repeat injections are recommended for extended pain relief.