Stellate Ganglion Blocks
What is a Stellate Ganglion Block?
A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck.
The stellate ganglion is a collection of nerves (sympathetic) found at the level of the sixth and seventh cervical vertebrae (the last vertebra of the neck). The nerves are located in front of the vertebrae.
They are part of the sympathetic nervous system and supply the face and arm. These nerves are not involved with feeling or movement. Sometimes, after a nerve is sensitized by trauma, infection or other causes, the sympathetic activity can cause pain.
Blocking the sympathetic activity by anesthetizing the stellate ganglion may stop the pain.
What is a stellate ganglion block done for?
A stellate ganglion block is done to:
- Diagnose the cause of pain in the face and head, arms and chest
- Manage pain in the head, neck, chest or arm caused by nerve injuries, the effects of an attack of shingles (herpes zoster) or angina that doesn’t go away
- Reduce sweating in the face, head, arms and hands
- Treat reflex sympathetic dystrophy, sympathetic maintained pain or complex regional pain syndrome
A stellate ganglion block can be either diagnostic—done to find the cause of a patient’s pain—or therapeutic—done to relieve the pain.
How a Stellate Ganglion Block is Done
During a stellate ganglion block, pain-relieving medicine is injected to the region where the ganglion lies. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain.
The patient is usually sedated, and using X-ray (fluoroscopy) guidance, a fine needle is placed near the stellate ganglion and anesthetic is injected.
The patient will not feel numbness in the face. They will have a droopy eye, redness of the eye, feel warmth in the face and may experience hoarseness of the voice. These effects are temporary and last a few hours. Pain relief may also not be immediate. A pain diary is used following the procedure to track the response.
How effective is a stellate ganglion block?
Some patients report pain relief immediately after the injection, but the pain may return a few hours later as the local anesthetic wears off. Other patients have longer term relief that outlasts the duration of the local anesthetic and helps them to reduce their medication use and increase their participation in physical therapy.
How long the pain relief lasts is different for each patient. Some may be pain-free for days or weeks. Usually people need a series of injections to continue the pain relief. Sometimes it takes only two injections; sometimes it takes more than 10. The relief tends to last longer with each treatment.
What are the risks?
The risk of complications from a stellate ganglion block is very low. However, there could be bruising or soreness at the injection site. Serious complications, including infection, bleeding and nerve damage, are uncommon.
Side effects of the procedure may include:
- Drooping eyelids
- Red or “bloodshot” eyes
- Nasal stuffiness
- Hoarse voice
- Feeling of a “lump” in your throat
- Difficulty swallowing
- Warmth or tingling in your arm or hand
These effects will subside within a few hours.
What happens after the procedure?
Do not drive or do any rigorous activity for 24 hours after your stellate ganglion block. Take it easy. You can return to your normal activities the next day.
When your voice returns to normal, you may begin to sip water through a straw and gradually work up to eating solid foods.