Stellate Ganglion Block
What is a Stellate Ganglion Block?
A stellate ganglion block is an injection of local anesthetic around "sympathetic nerve tissue" (the nerves which are a part of the Sympathetic Nervous System) located on either side of the "voice box" in your neck.
What is the purpose of this block?
This injection is done as a part of the treatment for the following conditions:
- Complex Regional Pain Syndrome (CRPS)
- Herpes Zoster (Shingles) that is affecting the face, the head, or an upper extremity (arm)
- Sympathetic Maintained Pain
The injection is used to "block" the Sympathetic Nerve Impulse. The primary goal of the stellate ganglion block is to decrease pain and swelling and to increase mobility of the affected extremity. Some secondary goals include enhancing coloring of the skin and improving sweating changes in the affected extremity.
How does the physician perform a Stellate Ganglion Block?
The physician's assistant may need to get some "baseline" temperatures on both of your arms. This is done by placing temperature-sensing pads on both extremities. An intravenous line (IV) may be started so that the physician can give you some "light" sedation to minimize any discomfort you may experience.
You will be positioned on your back with your chin slightly raised. Your skin on the front of your neck will be cleansed with an antiseptic solution.
The physician will numb the skin and the deeper tissues on the side of your neck by injecting a "local anesthetic" to block the nerve impulses. The physician will then insert the block needle and will inject a second local anesthetic closer to the nerve.
If fluoroscopy (x-ray) is going to be used to assist the physician with the placement of the "block", you will be taken to the Procedure Room. If there is a possibility that you could be pregnant, be sure to inform the staff.
What should I expect after the injection?
Immediately after the injection, you may feel your upper arm or leg on the injected side getting warmer. In addition, you may notice that your pain may be gone or decreased. You may also notice a "lump" in your throat. Your voice may also become hoarse and your eye on the injected side may become droopy and red. You may also develop some nasal congestion on the side of the injection. These changes will be temporary, but may last for several hours.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may perform activities that you can tolerate. With certain conditions, you may be encouraged to go to physical therapy after you leave the Pain Medicine Clinic. Your stay at the Pain Medicine Clinic will average 1 to 1 ½ hours.
May I go to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common side effect is usually soreness in the neck at the injection site.
How long will the effect of the medication last?
The local anesthetic wears off within a few hours. The block of the sympathetic nerve will vary from a few hours to several hours. The duration of relief may increase in length with each additional injection you receive.
How many injections do I need to have?
If you respond positively to the first injection, you may be scheduled for additional injections. Usually, a series of such injections is needed to treat the problem. Some patients may need only 2 to 4 injections, while other patients may need several injections.
Will the Stellate Ganglion Injection help me?
It is very difficult to predict if the injection(s) will indeed help you or not. Patients who come in early during their illness for treatment tend to respond better than those who have had their symptoms for several months.
What are the risks and side effects?
This procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The most common side effect is temporary pain. Other risks include bleeding, infection, spinal block, epidural block, pneumothroax, and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.
Who should not have a Stellate Ganglion Block?
If you are allergic to any medications to be injected, if you are on a blood thinner medication (e.g. Coumadin), or if you have an active infection, you should not have the injection. The physician may postpone the injection if you are currently on aspirin or an anti-inflammatory medication.