Stellate Ganglion Block

A stellate ganglion block is an injection into the small bundle of nerves (stellate ganglion) that carry rsd21“sympathetic” signals from the upper extremities (arms). The injection involves instillation of an anesthetic in the front of the neck toward either side. Certain injuries to the upper extremities cause unusual, burning pain, which is called complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD).

Why is the stellate ganglion block done?

By injecting a small amount of local anesthetic (usually Bupivacaine) on the stellate ganglion, the doctor can identify if or not the pain is carried via the sympathetic nervous system. This is a useful diagnostic test for CRPS. However, the anesthetic often is successful in blocking the pain, and other medications can be added for long-lasting relief of discomfort.

How long does it take to do the stellate ganglion block?

The actual injection only takes a couple of minutes, but the entire procedure takes around one hour. This includes discussing the procedure with the doctor beforehand, signing a consent form, being prepared in the procedure room, and the time for observation in the recovery room afterwards.

Does the stellate ganglion block hurt?

The doctor first injects a local anesthetic through a small needle into the skin, which feels like a pinch followed by slight burning. After the local anesthetic begins numbing the skin and tissues, the procedure only causes a pressure sensation at the injection site.

There is some pain during the procedure, but it is mild and temporary. If you prefer, you can have IV sedation to keep you comfortable. Most patients have little or no memory of the procedure when a sedative is given beforehand.

How is the procedure done?

You will be positioned on your back, and monitors are connected for blood pressure, heart rhythm, and oxygen monitoring. The skin of the neck is cleansed with an antiseptic solution, and the doctor numbs the skin with the local anesthetic. After this, the medication is instilled onto the stellate ganglion nerves under x-ray guidance.

stellate-ganglion-block-e1328696655805What should I do after the procedure?

Shortly after the medication is injected, you may feel your arm becoming warm and the pain will diminish quite a bit. Some patients experience temporary hoarseness and/or a slight droop around the eyelid on the side of the face where the injection occurs. These are expected side effects and only last a few hours.

How long do the effects of the block last?

The effects of the stellate ganglion block are difficult to predict. Blockade of the sympathetic nerves can last permanently, but for most patients it is only a temporary effect. Repeat injections may be required, but the doctor only does this when necessary.

What are the risks and complications of the stellate ganglion block?

Overall, the stellate ganglion block has few risks. However, as with other minimally invasive procedures, there are some complications. There could be increased pain, which is temporary, puncture of the epidural sack, injection into the blood vessels, bleeding, infection, and nerve damage.

Who should not have this procedure?

The following persons are not candidates for the stellate ganglion block:

  • Anyone allergic to anesthetics
  • Persons on Coumadin, Heparin, or other blood-thinning medicines
  • Individuals with an active infection

Do stellate ganglion blocks work?

In a study involving patients with CRPS, after a stellate ganglion block, patient pain was reported as 40% complete symptom relief, and 36% partial symptom relief. The results showed a positive correlation existing between SGB efficacy and how soon the SGB therapy is initiated. The effectiveness of the block depends on symptoms being present for less than 16 weeks before therapy.

Resources

Ackermann, WE & Zhang, JM (2004). Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome. Southern Medical Journal, 1084-1088.