Stellate Ganglion Blocks
The stellate ganglion (SG) is defined as the first thoracic ganglion (a bundle of nerves in the upper chest) or the conjoined first thoracic ganglion with the lowest cervical ganglion. In certain conditions, pain is transmitted through the sympathetic pathway. In the head and neck and upper extremity, this sympathetic pathway travels via the SG. Thus, the SG block aims to interrupt sympathetically mediated pain that travels through this relay.
ARE STELLATE GANGLION BLOCKS RIGHT FOR ME?
How do stellate ganglion blocks work to control my pain?
After careful placement of the needle using fluoroscopic guidance, at the base of the neck (at the level of the C7 or T1 vertebral body) and location confirmed using contrast dye, therapeutic medication is injected incrementally. The injectate disrupts the transmission signaling of the sympathetic nerves and thus sympathetically mediated pain.
PREPARING FOR TREATMENT
What should I expect during the procedure?
The sympathetic nerve block, depending on the condition it is treating, may be utilized as a single, isolated injection or may be repeated frequently depending on therapeutic benefit and efficacy. It is important to speak with your pain physician about the frequency of sympathetic blocks that may be necessary. For conditions such as CRPS, there is no consensus on the number of blocks needed to result in maximum benefit and patients benefit from a single injection or a series of injections in sequence.
What can I expect after the procedure?
With the stellate ganglion blockade, it is important to understand what is anticipated side effects of the procedure as well as potential complications. Transient eyelid droop, pupil changes, and lack of sweating as well as nasal stuffiness are all anticipated after the injection (a sign the sympathetic blockade is working); additionally one will notice decreased sweating of the affected limb and increase in skin temperature (on average 3 degrees C). It is very important you discuss with your pain physician the expected and associated effects of sympathetic nervous system blockade so that you know what to expect the day of the procedure.
Once the sympathetic blockade has been established, one should notice a progressive decrease in the sympathetically mediated pain. It is important to speak with your pain physician about the frequency of repeating sympathetic blocks.