A stellate ganglion block may be recommended for you if you are suffering pain in the face, head, arm, or chest that is not adequately relieved by other means. The block can be used either to diagnose the source of your pain or to treat it once it has been identified. The procedure requires light sedation, but you can go home the same day.
The Stellate Ganglion
The stellate ganglion is a cluster of nerve cells along a cable of nerves that runs through your neck. You have one stellate ganglion on each side of your neck. They lie just in front of the bottom two neck vertebrae. Sometimes these ganglia become overly sensitive due to an injury or infection. They may continue to send pain signals after the original condition has healed, or the injury itself may cause them to malfunction.
Conditions Treated by Stellate Ganglion Block
You may be a candidate for a stellate ganglion block if you have severe recurrent pain in the head, face, arms, and chest that is not eased by other methods such as medication or physical therapy. This may include reflex sympathetic dystrophy, shingles, refractory angina, phantom limb pain, and pain due to nerve injury.
A stellate ganglion block can also be helpful if you suffer from arterial disorders such as Reynaud Syndrome, sclerodoma, vasospasm and arterial trauma. Not only can the block alleviate pain, but it can counteract blood vessel constriction and allow more effective blood flow into the affected area.
Stellate Ganglion Block Procedure
The goal of a stellate ganglion block is to inject an anesthetic into the stellate ganglion of one side, thus temporarily stopping its ability to transmit pain signals. You will be lightly sedated during the procedure.
The block will be performed while you are lying face up on a table. The doctor will insert a thin needle through the front of your neck and into the stellate ganglion. A form of real-time X-ray, called fluoroscopy, or an ultrasound will be used to allow the doctor to track where the needle is going. Once it is in place, the anesthetic will be injected. This process takes less than 10 minutes. You may experience mild discomfort during the procedure, but it should not be painful.
After the injection, you will wait 10 to 20 minutes for the full effect of the block, during which time you will be monitored so the doctor can evaluate the results. What the doctor is expecting is a droopy and red eye on the side that the injection was performed, a warming sensation in the face, and possibly mild hoarseness. These signs are collectively called the Horner effect and, accompanied by a lessening of your pain, are the indications of a successful block. If you show the signs of the Horner effect but do not experience pain relief, that tells your doctor that your pain is caused by something other than the stellate ganglion and needs to be further evaluated.
After about an hour of recovery time, you will be allowed to return home. The drooping eye and hoarseness may last for up to six hours. If your arm was affected, it may be numb for a few hours, and you may need to wear a sling until it returns to normal. You will also be asked to keep a pain diary. The diary is a record of how much pain relief you experience and how long it lasts. Your doctor will use this information to guide your future treatments.
If a stellate ganglion block proves to be an effective treatment for your head, face, arm, or chest pain, you will likely need to repeat the procedure a few times to achieve lasting results. The number of treatments suggested and the degree of pain relief they provide varies between individuals.
Contraindications and Complications
The stellate ganglion block is not appropriate for you if you have a coagulation disorder. It is also not available to people who have recently suffered a myocardial infarction or who have pathological bradycardia or glaucoma.
Adverse outcomes from the stellate ganglion block are unusual, but they include infections and injuries from the needle. The use of fluoroscopy or ultrasound while the needle is being inserted greatly decreases the chance of this type of injury.