Presentation
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.
Patient Data
Neurolytic-contrast spread over the ganglion.
Left ptosis.
Case Discussion
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.
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.
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.
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