The stellate ganglion is an aggregate of nerve tissue formed by the inferior cervical and the first thoracic ganglia. This provides sympathetic signals to the upper extremities, head, neck and heart. Some conditions result in over-excitation of sympathetic stimuli, causing pain, and some observable changes to the upper extremities, or face. A stellate ganglion block is the injection of a local anesthetic to modulate, or “block”, the signals causing the symptoms.
This procedure can provide diagnostic value in identifying the underlying causes of pain, as well as therapeutic value in relieving the symptoms of the patient.
What conditions benefit from a stellate ganglion block?
This procedure is mainly used to relieve the symptoms of Complex Regional Pain Disorder (also formerly known as reflex sympathetic dystrophy). Its use has also been found to be effective in relieving pain from refractory angina, herpes zoster, and even phantom limb pain. Cases of vascular insufficiency, such as Raynaud syndrome, vasospasm, emboli, and venous insufficiency, have also been shown to respond to this procedure.
Other studies have explored the possible use of stellate ganglion block for the treatment of hot flushes in menopausal women and breast cancer survivors, with positive results. The procedure has also been demonstrated to relieve anxiety symptoms from post-traumatic stress disorder. It has also been found to be an effective modality of treatment for refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage, and atypical forms of facial pain.
How is a stellate ganglion block done?
The procedure is usually done under sedation, although local anesthesia may also be used. Vital signs (blood pressure, heart rate, respiratory rate) will be monitored throughout the operation. Local anesthesia may be used to numb the injection site of the needle. The insertion site will be prepped with antiseptic solution, and the surrounding area will be draped to enhance sterility.
The insertion of the needle can be done under fluoroscopic (X-ray) or other imaging guidance (such as MRI, CT scans, and ultrasound), and techniques using surgery have been associated with better outcomes. However, the traditional technique for a stellate ganglion block is “blind”; i.e., the physician will be guided by anatomic landmarks. This technique is more prone to failure and potentially more adverse effects.
The procedure can take anywhere from 15 to 30 minutes, depending on the circumstances of the case. The patient is kept in recovery for at least 30 minutes after the procedure, and can be sent home within the day if recovery permits it.
What are the outcomes and risks of a stellate ganglion block?
Most patients can easily tolerate the procedure, and majority report positive outcomes for weeks or even months after the procedure (injection with corticosteroids aside from local anesthetics gives longer effect). Since the relief of symptoms is only temporary, repeat blocks will be needed throughout the year. The response and frequency of follow-up blocks will depend on the individual circumstances of the patient.
There are always risks associated with a stellate ganglion block. These include surgical site infection, intraoperative damage to muscle, nerves, or nearby soft tissues, bleeding, pneumothorax, hemothorax, among others. However, adverse outcomes are rarely reported, especially if the procedure is done under image guidance.
Alino J, Kosatka D, McLean B, Hirsch K. Efficacy of stellate ganglion block in the treatment of anxiety symptoms from combat-related post-traumatic stress disorder: a case series. Mil Med. 2013 Apr;178(4):e473-6. doi: 10.7205/MILMED-D-12-00386.
Haest K, Kumar A, Van Calster B, et al. Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: an uncontrolled experimental study with 24 weeks of follow-up. Ann Oncol. 2012 Jun;23(6):1449-54. doi: 10.1093/annonc/mdr478.
Kastler A, Aubry S, Sailley N, et al. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb. Eur Radiol. 2013 May;23(5):1316-22. doi: 10.1007/s00330-012-2704-y.
Othman AH, Zaky AH. Management of Hot Flushes in Breast Cancer Survivors: Comparison Between Stellate Ganglion Block and Pregabalin. Pain Med. 2014 Jan 14. doi: 10.1111/pme.12331.
Shankar H, Simhan S. Transient neuronal injury followed by intravascular injection during an ultrasound guided stellate ganglion block. Anesth Pain Med. 2013 Winter;2(3):134-7. doi: 10.5812/aapm.7823.