Stellate ganglion block

Case contributed by Dr Charudutt Jayant Sambhaji
Modality: CT

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Modality: Photo

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Case Discussion

35year old female with post trauma reflex sympathetic dystrophy  in her left upper limb. Multiple attempts at pain relief using anesthetic drugs had not relieved her symptoms. Hence CT guided neurolytic stellate ganglion block was performed using absolute alcohol.

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, hyperhidrosisof 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.

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.

Complications: Pneumothorax, bleeding, infection, allergic reaction, intravascular injection and its consequences, phrenic nerve or recurrent laryngeal nerve palsy, hypotension, injury to adjacent vascular structures (particularly the vertebral artery), and bradycardia. 

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. 

References

1.      Erickson SJ, Hogan QH. CT-guided injection of the stellate ganglion: description of technique and efficacy of sympathetic blockade. Radiology Sep 93;188(3):707-92.

2. Interventional Radiology in Pain Treatment.   2007 Edn. [Springer BerlinHeidelberg]   Bruno Kastler ,Fabrice-Guy

Barral, Bernard Fergane and Philippe Pereira (Editors) 

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. Image-guided Stellate Ganglion Blocks. Andrew L Wagner.  eMedicine.

5. Hogan QH, Erickson SJ, Abram SE. Computerized tomography-guided stellate ganglion blockade. Anesthesiology. Sep 1992;77(3):596-9

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Case Information

rID: 5911
Case created: 29th Mar 2009
Last edited: 2nd Sep 2015
System: Head & Neck
Inclusion in quiz mode: Excluded

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