Stellate Ganglion Block

Performed By Top Pain Management Doctors In Fort Smith, Arkansas

A stellate ganglion block has a wide array of therapeutic  and diagnostic indications, including:

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Pain Syndromes

  • Sympathetically-maintained pain syndromes
  • Complex Regional Pain Syndromes Type 1 and 2
  • Reflex sympathetic dystrophy
  • Shoulder/hand syndrome
  • Causalgia (nerve injury)
  • Phantom limb pain
  • Intractable angina
  • Herpetic neuralgia from herpes zoster (shingles)

Vascular Insufficiency in Upper Extremities

  • Arterial insufficiency
  • Raynaud’s phenomenon
  • Scleroderma

Miscellaneous

  • Hyperhidrosis (excessive perspiration) of the face and upper extremities
  • Hot flushes and sleep dysfunction related to hot flashes
  • Posttraumatic stress disorder (PTSD)

Anatomy:

The stellate ganglion is the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion where they meet over the vertebral body of C7 It is in close proximity to the carotid sheath, phrenic nerve, and recurrent laryngeal nerve.

Procedure:

A stellate ganglion block is an injection of local anesthetic into the sympathetic nerve tissue in the neck area. These nerves are part of the larger sympathetic nervous system and are located on both sides of the voice box. There are several methods by which the stellate ganglion block can be performed, and all of them take under one hour. Correct placement is also confirmed by administration of contrast dye. Once position is confirmed local anesthetic is administered. A successful block is marked by profound pain relief and improved vascular flow to ipsilateral upper extremity. A local anesthetic is usually injected to assist with the discomfort. For patients who have a documented response to administration of local anesthetic onto the stellate ganglion, a therapeutic block can be performed. Radioablation of the stellate ganglion is also another treatment for longer-lasting pain relief.

Some patients may experience symptoms from Horner’s Syndrome (drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block was preformed). This is normal and will usually subside when the anesthetic wears of (usually ~4-6 hours after the block is preformed).

Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs for a while after the procedure and place you in a sitting position to facilitate the spread of the anesthetic.

Benefit:

Stellate ganglion block is a short, minimally invasive procedure that can effectively treat a wide array of conditions that have not responded to other treatments. These include relief for sympathetic-related facial pain, chest and upper extremity pain, circulation improvement in upper extremities and face, decreasing perspiration in upper extremities and face, decreasing hot flashes and associated sleep disturbances, and it is even showing promise as a novel treatment for PTSD.

Risk:

The risks for the procedure are typically low. As with all medical procedures, there is some risk, however. These include – misplacement of the needle resulting in: bleeding, nerve injury, pneumothorax (collapsed lung), or esophageal perforation.

There are, also, risks that can occur because of the anesthetic. These include, drug allergy, seizure (if the medication is injected into a blood vessel), brachial plexus block (numb arm on side of block that lasts as long as the life of the anesthetic injected), spinal or epidural block (transient weakness and/or numbness from neck down as long as the life of the anesthetic injected), hoarseness (from anesthetizing recurrent laryngeal nerve), and shortness of breath (from anesthetizing phrenic nerve).

Lastly, as with all punctures of the skin, the risk of infection always exists. The most common side-effects related to the procedure are drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block as well as voice becoming more hoarse. These side effects usually subside after the anesthetic wears off.

Outcomes:

After the block is preformed one of three things may occur:

  1. Your pain is gone or greatly improved and stays that way for longer than the life of the anesthetic. This shows your physician that the block has therapeutic value for you and he or she can come up with a treatment plan that maximizes your pain control
  2. Your pain is unchanged but, there is evidence of a sympathetic blockade. This is of diagnostic value to your physician and tells him or her that your pain is not responsive to a sympathetic block and he or she can try other treatment modalities to treat your pain.
  3. Your pain is unchanged but there is no evidence of a sympathetic blockade. This indicates that the block was a technical failure.

Stellate ganglion blocks are a well-established treatment method  for providing relief from sympathetically-maintained pain syndromes. However, their benefits do not end there. Listed above, are the many of the benefits. Additionally, some people tend to have relief for weeks, while others benefit from the block for years. Fortunately, the procedure is a low risk, nonsurgical treatment that if successful the first time, will most likely continue to provide pain relief with repeat treatments. If you are suffering with pain contact Arkansas Pain today to see if you can benefit from a stellate ganglion block. We are happy to offer this exciting treatment option to patients in the Merritt Island and Melbourne area. Call today.

Journal Articles:

  1. Stellate Ganglion Block – com 
  2. Chester M, Hammond C, Leach A. Long-term benefits of stellate ganglion block in severe chronic refractory angina. Pain. 2000 Jul;87(1):103-5.
  3. Elias M. Continuous cervico-thoracic sympathetic ganglion block: therapeutic modality for arterial insufficiency of the arm of a neonate. Middle East J Anesthesiol. 2001 Oct;16(3):359-63.
  4. Gofeld M, Bhatia A, Abbas S, Ganapathy S, Johnson M. Development and validation of a new technique for ultrasound-guided stellate ganglion block. Reg Anesth Pain Med. 2009 Sep-Oct;34(5):475-9.
  5. Klyscz T, Jünger M, Meyer H, Rassner G. Improvement of acral circulation in a patient with systemic sclerosis with stellate blocks. Vasa. 1998 Feb;27(1):39-42.
  6. Lagade M, Poppers PJ: Stellate ganglion block: A therapeutic modality for arterial insufficiency of the arm in premature infants. Anesthesiology. 1984;61:203-204.
  7. Lipov EG, Joshi JR, Sanders S, Slavin KV. Lipov EG, Joshi JR, Sanders S, Slavin KV. 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. 2009 Jun;72(6):657-61. Epub 2009 Feb 23.
  8. Lipov EG, Joshi JR, Lipov S, Sanders SE, Siroko MK. Cervical sympathetic blockade in a patient with post-traumatic stress disorder: a case report. Ann Clin Psychiatry. 2008 Oct-Dec;20(4):227-8.
  9. Lipov EG, Joshi JR, Sanders S, Wilcox K, Lipov S, Xie H, Maganini R, Slavin K. Effectsof stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncol. 2008 Jun;9(6):523-32. Epub 2008 May 15.
  10. Marples, IL, Atkin RE. Stellate ganglion block. Pain Rev 2001; 8: 3-11.
  11. Moore R, Groves D, Hammond C, Leach A, Chester MR. Temporary sympathectomy in the treatment of chronic refractory angina. J Pain Symptom Manage. 2005 Aug;30(2):183-91.
  12. Narouze S, Vydyanathan A, Patel N. Pain Physician. Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture. Pain Physician. 2007 Nov;10(6):747-52.
  13. Shibata Y, Fujiwara Y, Komatsu T. A new approach of ultrasound-guided stellate ganglion block. Anesth Analg. 2007 Aug;105(2):550-1.
  14. Stanik-Hutt JA. Management options for angina refractory to maximal medical and surgical interventions. AACN Clin Issues. 2005 Jul-Sep;16(3):320-32.