Note: This procedure must be performed under x-ray fluoroscopic guidance by MD or DO physicians only.
What is the Stellate Ganglion?
The sympathetic nervous system is a primitive alternative nervous system that exists in our bodies and usually is outside our conscious control. It controls the amount of blood going through the arteries, the heart rate, breathing rate, etc. The stellate ganglion is a main control station for the sympathetic nervous system in the neck and controls the blood flow and certain pain sensors in the face, neck, arm, hand, and upper chest. In some diseases, the nerve signals going through this switching station are overactive and can be interrupted by injection of a local anesthetic into this ganglion.
What Conditions does Stellate Ganglion Block (SGB) Treat?
Headaches, recurring facial pain, complex regional pain syndrome, some types of cancer pain, and sympathetically mediated diseases, or for excessive sweating. Clinical studies have also shown SGB to help with symptoms of Post Traumatic Stress Disorder and the effects of Long-Term COVID. The injections may be used as a diagnostic injection or in a series as therapeutic injections. However, if more than 3 injections are needed, usually your doctor will then consider other technologies such as spinal cord stimulation as a permanent alternative.
How is the Injection Performed?
The injection is always performed under x-ray fluoroscopic or ultrasound guidance, usually with local anesthesia given into the skin over the site of the injection. After skin preparation and placement of local anesthesia in the skin, a small needle is inserted at the base of the neck, and advanced to the C7 vertebrae. Injection of iodinated contrast ( if done fluoroscopically) shows the needle tip is not in a blood vessel and therefore local anesthesia can safely be injected. Under ultrasound we can see the blood vessels to avoid them. Usually Lidocaine is injected and the local anesthetic will track down the sympathetic nerves to the stellate ganglion that lies just below. You will be sat immediately after the needle is out. Onset of pain relief is nearly immediate if the sympathetic nervous system is carrying the painful signals through this ganglion. You will continue to assess the degree of pain relief over the next several hours. A series of these blocks is a reasonable choice to desensitize the nervous system, but if more than 3 blocks are used in a 3 month time period, other alternatives need to be considered.