The stellate ganglion is a bundle of sympathetic nerves that are located at the base of the cervical spine or neck. These nerves exit the spine and impact the face, shoulder and arms. When injury, illness or other conditions impact the stellate ganglion, it can cause localized and radiating pain. Possible diagnostic and treatment options include stellate ganglion block injections.
What is the stellate ganglion block?
The Stellate Ganglion (or cervicothoracic ganglion) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion, which exists in 80% of cases. The Stellate ganglion is located at the level of C7 (7th cervical vertebrae), anterior to the transverse process of C7, superior to the neck of the first rib, and just below the subclavian artery.
Clinical indications
The clinical significance of these ganglia is that they may be blocked in order to decrease the symptoms exhibited by
- Raynaud’s phenomenon-whitening of the hands due to constricted circulation causing pain
- Hyperhydrosis(extreme sweating) of the hands.
- Sympatheticallymediated pain such as complex regional pain syndrome type I (reflex sympathetic dystrophy).
- Post Traumatic Stress Disorder (PTSD).
- Blunt needling of the stellate ganglion with anacupuncture needle is used in Traditional Chinese Medicine to decrease sympathetically mediated symptoms as well.
- Block of the stellate ganglion has also been explored incoronary artery bypass surgery.
- Has potential as a means of reducing the number of hot flashes and night awakenings suffered by breast cancer survivors and women experiencing extreme menopause
How is a Stellate Ganglion Block Performed?
If you are scheduled for a stellate ganglion block, you will be receiving an injection in the front of the neck, either to the right or left. The stellate ganglion, a small nerve bundle which carries pain signals from the upper extremities, is injected with a local anesthetic to determine whether your specific pain is being transmitted by the sympathetic nervous system.
For diagnostic purposes, a local anesthetic, such as Bupivacaine or Lidocaine are injected into the stellate ganglion. If the diagnostic injection relieves your pain, other medications may be injected to achieve long-lasting pain relief. When the anesthetic is injected, you may feel your arm becoming warm, and may experience a significant lessening of pain.
How long will my stellate ganglion block last and are there side effects?
Most patients receive at least temporary relief, although for some, the pain relief can be permanent. A significant number of those who receive a stellate ganglion block will receive a subsequent block to keep the pain at bay. While this procedure is generally considered safe, with few risks, some side effects of a stellate ganglion block include:
- Injection
- Increased pain from the injection
- Nerve damage
- No relief from the normal levels of pain
- Bleeding
- Inadvertent puncture of the spinal fluid sack
- Inadvertent injection into the blood vessels in the neck
If you are allergic to any of the medications, currently have an active infection or are on blood thinning medications, you should not have this procedure done.
When booking the procedure?
On the day of booking your procedure, please advise staff if you are –
- Taking blood thinners (especially warfarin and clopidogrel)
- Diabetic
- Pregnant, or any chance of being pregnant
Allergic to:
- Shellfish
- Steroids
- Local anaesthetics
- Iodine
- Betadine
- Chlorhexidine
- Unwell or have an infection
DAY OF THE PROCEDURE
- DO NOT eat or drink (for 6 hours before your procedure),
- TAKE your usual medications with a small amount of water (apart from those mentioned previously), and
- ARRANGE for someone to accompany you home.
DURING THE PROCEDURE
After arriving you will need to complete the necessary paperwork. Then –
- You will change into a hospital gown,
- A small drip will be inserted into one of your veins,
- You may be given a mild sedative,
- Your heart rate and blood pressure will be monitored throughout the procedure,
- You will lie face down on an x-ray table, then the skin over the area to be injected will be cleaned with an antiseptic solution,
- A sterile barrier will be created,
- A local anaesthetic will be injected to numb the area,
- You will be asked to map out your pain distribution,
- An x-ray machine will be used to guide a small needle towards the nerve,
- You may experience some discomfort, however this usually subsides and can be treated with icepacks and medication.
AFTER THE PROCEDURE
- You will be monitored in a recovery area until you are ready to go home. This usually takes between 60 – 120 minutes.
- You will be given a pain relief chart to fill out. SHOW this to your doctor at your next consultation.
- Preferably, someone will take you home and stay with you for the next 24 hours.
- Pain may return when the anaesthetic wears off. Some people experience an initial increase in pain and stiffness, which may continue for several days. If necessary you may apply an ice pack to the area for 20 minutes at a time, for 1-2 days following the procedure.
- You may take simple pain-killers such as Paracetamol to ease any discomfort.
- Remove any dressing the day after your procedure.
- Avoid a rapid increase in your activities. Gradually increase your daily activities as tolerated. Discuss this with your doctor.
- If steroids were injected, it may take several days for the benefits to be noticed. Additionally, you may feel flushed in the face and/or notice a change in your mood for a few days. Diabetic patients may notice a rise in blood sugar levels.
- If you have received sedation during your procedure, the effects may last up to 24 hours. Due to the effects, you may not remember some of the information given to you during the procedure.
COMPLICATIONS
Common Complications
- Horner’s Syndrome (this should always be present if the injection has worked correctly (see above picture) it only lasts for approximately 1 day and can give mildly blurred vision in the affected eye for that period
- Continuing PTSD (if this was the reason for the injection) ie injection failure
- Minor bleeding in the area injected
- Bruising in the area injected
- Temporary weakness or numbness from the local anaesthetic
- Side effects from the steroid (if injected)
- Brief increased pain that may fluctuate
- Short term high/low Blood Pressure
More Serious but much Rarer Side Effects
- Intra-arterial or intravenous injection of local anaesthetic causing difficulty swallowing, vocal cordparalysis, epidural spread of local anaesthetic, seizure
- pneumothorax.
- Permanent nerve injury to the including weakness,
- Allergy to the anaesthetic or steroid used in the sedation or as part of the procedure
- Increase of any pre-existing medical condition such as cardiac conditions
- Brief mild to moderate increase in pain that involves a burning sensation (this is easily treated with a simple pain relief)
- Damage to the blood vessels around the injection on rare occasions
- Infection
- Bruising around the area from needle trauma