The stellate ganglion block is an injection of local anesthetic at the level of the neck to target the stellate ganglion, a sympathetic ganglion. The goal is to interrupt abnormal autonomically-mediated pain as well as the treatment of certain cardiovascular and psychiatric disorders. The stellate ganglion is located anterior to the transverse processes of C6 and 7 vertebrae and deep to the carotid artery. This procedure is most commonly performed nowadays under ultrasonography for dynamic needle and soft tissue/vascular visualization, but can also be performed by palpation and/or fluoroscopy.
Coverage that can be achieved with this block:
Blockade of the stellate ganglion affects the sympathetic/autonomic innervations of the ipsilateral face, upper extremity and can also have psychiatric impacts.
Stellate ganglion blocks serve two purposes: diagnostic and therapeutic. Whether or not the pain (or disorder of interest) is predominately mediated by the autonomic nervous system via the stellate ganglion will determine whether the patient will experience a clinical response; this serves a diagnostic purpose regardless the outcome.
If the patient reports a favorable response, the therapeutic duration of the block depends in part on the duration of action of the chosen local anesthetic as well as the response of the individual to the block. Some patients may experience relief that outlasts the expected duration of the local anesthetic and this is thought to be due to remodeling or interruption of the autonomic signaling.
Repeated subsequent injections may lead to progressive increased response duration. There are no practical continuous catheter infusion options available.
Indications
- Complex regional pain syndrome, phantom limb pain, or other chronic neuropathic pain in the ipsilateral upper extremity
- Ipsilateral facial, neck pain
- Herpes zoster (shingles)
- Pain associated with intractable angina
Dosing
- Usually 10ml of 0.25% bupivacaine or ropivacaine
Important contraindications and side effects
- Relative contraindications include antithrombotic use and active infection.
- Rare but possible risks include seizure (intravascular injection), pneumothorax, epidural/spinal spread (temporary weakness and numbness from the neck down), bleeding, nerve injury, or infection.
- There are expected changes from a sympathetic block (which is used as a marker for a technically successful block) – Horner’s syndrome (ptosis, miosis, anhidrosis, increase in temperature, rhinorrhea, corneal injection).
- numbness/weakness may occur from local anesthetic spread to the brachial plexus block. These symptoms last for the duration of the local anesthetic used.
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