A stellate ganglion block can be used to treat a number of conditions by reducing stimulation of the stellate ganglion which is part of the sympathetic network.
The ganglion is formed by the inferior cervical and first thoracic ganglia and is located just anterior to the head of the first rib. It receives input from the paravertebral sympathetic chain and provides sympathetic efferents to the upper extremities, head, neck, and heart. The infiltration of local anesthetic / neurolytic around the 1cm ganglion has been used to treat a variety of disorders.
The stellate ganglion is a long, flat structure approximately 1 cm in length. It lies just anterior to the head of the first rib, directly adjacent to the vertebral artery and lateral to the longus colli muscle. It is also closely related to the apex of the lung and the phrenic nerve.
Indications for stellate ganglion blocks include reflex sympathetic dystrophy of the upper extremities, Raynauds disease of the upper extremities, herpes zoster of the face or neck, hyperhidrosis of the neck of an upper extremity, and upper extremity pain due to arterial insufficiency.
Contraindications are current coagulopathy, recent myocardial infarction, pathologic bradycardia, and glaucoma.
The procedure can be done by either palpating anatomical landmarks (done mainly by pain therapists) or under fluoroscopic, ultrasound or CT guidance. Using CT guidance the stellate ganglion; which comprises of lower cervical and D1 sympathetic ganglia overlying the C7 & D1 transverse process can be accurately targeted and hence a lower volume of drug needs to be delivered. Complications rates are also low as the ganglion is accurately targeted.
- allergic reaction
- intravascular injection and its consequences
- phrenic nerve or recurrent laryngeal nerve palsy
- injury to adjacent vascular structures (particularly the vertebral artery)
Anesthetic drugs like bupivacaine, buprenorphine are commonly used with short term relief. Absolute alcohol is injected to induce permanent neurolysis. Recently RF ablation is also used to cause permanent neurolysis of Stellate ganglion.
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- 3. W.Ackerman, M.Ahmad. The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand. Regional Anesthesia and Pain Medicine,Volume 24, Issue 3, Page 275.
- 4. Hogan QH, Erickson SJ, Abram SE. Computerized tomography-guided stellate ganglion blockade. Anesthesiology. Sep 1992;77(3):596-9