Stellate Ganglion Block

What is a stellate ganglion block?

A stellate ganglion block is a type of injection that stops nerve signaling from nerves in the neck at the sides of the voice box. This collection of cervical nerves—the stellate ganglion—are responsible for delivering many sensations (including pain signals and movement messages) to the brain. When these nerves are injured or otherwise compromised, a stellate ganglion block can help relieve pain, swelling, sweating, poor circulation, and poor mobility in the upper extremities.

Stellate ganglion blocks can also be used diagnostically. If you experience pain relief, reduced swelling, and increased circulation and mobility, it confirms that the stellate ganglion is involved in your pain. This can help lead to a diagnosis of the underlying condition leading to pain.

Once you receive a block, several things may happen:

• Your pain may not be relieved but other symptoms are, which means that the underlying condition is not related to the stellate ganglion (but another block might still be an option)
• Your pain is unrelieved, and you have no other symptom relief (the block is a failure)
• Pain and symptoms resolve (success)

How can a stellate ganglion block help me?

A stellate ganglion block helps with diagnosis and offers relief of pain and other symptoms. There are a variety of conditions that can be treated with a stellate ganglion block, including:

• Complex regional pain syndrome (CRPS)
• Shoulder/hand syndromes
• Causalgia (nerve injury)
• Phantom limb pain
• Intractable angina
• Shingles (herpetic neuralgia from herpes zoster)
• Poor circulation in the upper extremities
• Raynaud’s phenomenon
• Scleroderma
• Excessive sweating (hyperhidrosis) in the face and upper extremities
• Hot flashes and sleep dysfunction related to hot flashes
• Post-traumatic stress disorder (PTSD)

Some patients experience immediate, near-total relief from their pain and other symptoms with a stellate ganglion block. Others find at least partial relief in the days and weeks that follow. If the block is successful, many doctors find that a series of blocks offers the most relief.

Patients who have already tried other pharmacological treatments may find relief with a stellate ganglion block. Your doctor can also tailor the type of medications injected to best treat your individual symptoms.

An overview of the stellate ganglion block procedure

This procedure usually takes less than 15 minutes and is done on an outpatient basis. You receive IV sedation, depending on your comfort level. Your vital signs—heart rate, blood pressure, and temperature—are monitored throughout the procedure.

Once you are relaxed and positioned on the examination table, face up and with a pillow under your shoulder blades, your doctor cleans the area to receive the block. They then administer a local anesthetic. Even under sedation, you might feel a stinging sensation or pinch from this anesthetic, but it quickly goes away.

Your doctor presses into your neck to determine the site of the injection. It is important to stay absolutely still. No talking, coughing, or swallowing during the injection. Movement can cause the needle to be improperly placed.

Unlike other blocks, a stellate ganglion block can be completed without X-ray guidance. Though, as an added precaution, your doctor may choose to use X-ray guidance. Once the needle is in place, they’ll inject the medication. This may include an anesthetic, a steroid, or both.

After the procedure, you move to a recovery room for 30 minutes to an hour. Your pain and vital signs are monitored during this time, too.

You can learn more about this procedure in the following video.

Will the stellate ganglion block hurt?

Before the block, your doctor will firmly press on your neck to locate the proper initial placement. This can be uncomfortable but is usually brief.

Additionally, you may feel the sting of the local anesthetic before the procedure and some lingering soreness in the days after at the injection site. Both of these are normal and usually mild.

Side effects

The risks of stellate ganglion block side effects and complications are low, but it’s important to understand the potential for them.

Directly after the block, some patients may experience symptoms known as Horner’s syndrome. This includes drooping of the upper eyelid, pupil constriction, and decreased sweating. This is a normal response. Symptoms usually subside when the anesthetic wears of (usually within four to six hours after the procedure).

Additional rare side effects and risks include:

• Red eyes
• Feeling like you have a “lump” in the throat
• Difficulty swallowing
• Misplacement of the needle resulting in bleeding
• Nerve injury
• Collapsed lung (pneumothorax)
• Esophageal puncture
• Hoarseness
• Shortness of breath
• Allergic reaction
• Numbness in the arm on the side of the block
• Weakness and/or numbness from neck down as long as the life of the injected anesthetic

Many of these side effects are short-lived and minor. If you have an active infection, fever, cold, or very high blood pressure, your doctor will not perform a stellate ganglion block until these conditions improve. Talk to your doctor if you are on blood thinners, as this may hinder your ability to receive this block.

Recovery

Recovery is usually swift and easy. You will not be able to drive home on the day of your procedure and should ask a friend or family member for help. Relax for the remainder of the day of your stellate ganglion block.

Your doctor will provide detailed recovery instructions, but general guidelines include:

• Use ice packs to relieve any minor pain or swelling at the injection site.
• Difficulty swallowing may occur, but this is temporary. Do not drink, eat, or attempt to swallow anything for four hours after your procedure. Choose easy-to-swallow foods until your throat feels open and able to properly swallow.
• Although strenuous activity should be avoided for at least 24 hours after the block, you can return to your normal activities the next day.

Although this procedure is generally recognized as safe, there are a few important issues to watch for. If you experience any of the following symptoms, call your doctor immediately.

• Severe pain
• New numbness or weakness in the extremities
• Temperature of 100.5 or greater
• Redness, swelling, warmth, or discharge at the injection site

Fortunately, stellate ganglion block is a low-risk, non-surgical treatment. If it’s successful the first time, it will most likely continue to provide pain relief with repeated treatments.