A stellate ganglion block is an injection of local anesthetic in the sympathetic nerve tissue of the neck. These nerves are a part of the sympathetic nervous system. The nerves are located on either side of the voice box, in the neck.
Many times we do radiofrequency ablation of stellate ganglion to get longer duration of effect.
A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility.
It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm or the head and face. It is also helpful in vascular pain of upper limb.
The actual injection takes only a few minutes.
The injection consists of a local anesthetic. Steroid medication may be added to prolong the effects of the stellate ganglion block.A newer advance of Radiofrequency has got a very good effect in stellate ganglion.
The stellate ganglion block involves inserting a needle in the neck through skin and deeper tissues. So, there is some pain involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle.
The stellate ganglion block can be done under local anesthesia only. However, most of the patients also receive enough intravenous sedation that they may fall asleep for a few minutes during the actual injection.
Patients breathe on their own throughout the procedure. The amount of sedation given generally depends upon the patient tolerance, but can often be enough that the patient has amnesia for the actual injection.
It is done either with the patient slightly sitting up. The chin is slightly raised and turned away from the side to be injected. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device.
Temperature sensing probes are also placed on your hands. The skin in the front of the neck, next to the “voice box” is cleaned with antiseptic solution and then the injection is carried out.
Immediately after the injection, you may feel your arm getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice “a lump in the throat” as well as hoarse voice, a droopy and red eye and some nasal congestion on the side of the injection. You may rarely also develop a headache.
You should have a ride home. We advise patients to take it easy for a day or so after the procedure. You can perform the activities that you can reasonably tolerate. Some patients may go for immediate physical therapy.
Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is soreness in the neck at the injection site.
The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.
If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.
It is sometimes difficult to predict if the injection will indeed help you or not. The patients who present early during their illness tend to respond better than those who have had symptoms for a very long time. Patients in advanced stages of disease may not respond adequately.
This procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, spinal block, epidural block and injection into blood vessels and surrounding organs. Fortunately, serious side effects and complications are very uncommon.
If the patient is allergic to any of the medications to be injected, on a blood thinning medication, has an active infection going on near the injection site, or has poorly controlled diabetes or heart disease, they should not have the injection or at least consider postponing it if postponing it would improve your overall medical condition.