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 infiltration of local anaesthetic/neurolytic around the 1 cm ganglion has been used to treat a variety of disorders.
Indications for stellate ganglion blocks include reflex sympathetic dystrophy of the upper extremities, Raynaud's 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 T1 sympathetic ganglia overlying the C7 and T1 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.
Anesthetic drugs like bupivacaine and 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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