A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck that is typically ordered by your doctor for pain located in the head, neck, chest or arm caused by sympathetically maintained pain (reflex sympathetic dystrophy), causalgia (nerve injury), herpes zoster (shingles), or intractable angina. Stellate ganglion blocks are also used to see if blood flow can be improved in circulation problems typically from Raynaud’s. Stellate ganglion blocks may be therapeutic and/or diagnostic. One of three things may happen. 1. The pain does not go away and there is other evidence of a sympathetic block – the pain is not responsive to sympathetic blocks -this is of diagnostic value. 2. The pain does not go away and there is not good evidence of a sympathetic block – the block is a technical failure. 3. The pain goes away after the injection and stays away longer than the life of the local anesthetic – the block was of therapeutic value. The procedure will most likely have to be repeated to get long lasting benefit. The spacing of injections will be based on how long the pain relief is between injections (usually you will get longer benefit after each injection).
Note: The procedure can not be performed if you have an active infection, flu, cold, uncontrolled cough, fever, very high blood pressure or if you are on blood thinners. Please make your doctor aware of any of these conditions. This is for your safety!
Risks of the procedure
The risks of the procedure, though infrequent, include seizure – if the medication is injected into a blood vessel; pneumothorax (collapsed lung); brachial plexus block (numb arm that lasts for hours); spinal or epidural block (temporary weakness or numbness from the neck down); allergy to medication, nerve damage, and bruising at the injection site.
There are some expected changes that result from blocking the sympathetic nerves. These changes last for the life of the local anesthetic (about 4 – 6 hours). They include drooping of the eyelid on the injected side, “bloodshot eye” on the injected side, stuffy nose on the injected side and a temperature increase on the injected side. You may also get hoarseness.
The doctor has to press on your neck to locate the area to be injected. Many patients find this awkward and somewhat uncomfortable. The injection itself is done using a very small needle. The local anesthetic stings/burns going in.
A consent form will be signed, your vital signs checked and an IV started if needed. Skin temperature monitors will be placed on both your hands. You will be asked what your pain score is on a scale of 0 – 10. The procedure will be done with you lying on your back with a sheet rolled up between your shoulder blades. Your neck will be cleansed with an antiseptic soap. Fluoroscopy may be used to help with the procedure. The doctor will press on your neck to identify where to place the needle. At this time we’ll ask that you try not to talk, cough, or swallow. When the needle is in the correct place, the medicine (local anesthetic) is put in through the needle. The needle is removed and the procedure is complete. This usually takes about 5 – 10 minutes. If your pain is usually in your head you will remain lying down; if your pain is usually in your arm you’ll be asked to sit up so the medicine spreads down. The medicine can take 10 – 20 minutes to take full effect. You will be watched during that time. Your doctor will be checking to see if the expected changes take place as well as see what effect if any there is on your pain. Your pulse and blood pressure will be checked. If all is well, your intravenous will be removed. You doctor will authorize your discharge when you’re ready and your ride is present.
After the procedure
Your neck may be tender or bruised feeling after the injection. One eye will be droopy. This may affect your sense of balance. You may get hoarseness. If you do you must be careful swallowing. If your arm gets numb or heavy you will have to protect it (sling) until sensation returns – usually 4 – 6 hours. You may take your usual pain medications after the injection. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.
You may not drive for the remainder of the day after the procedure. It is best for an adult to be present to drive you home or to go with you in a taxi or on public transportation. This is for your safety.
Be careful swallowing after the injection (sips of water first) especially if you get hoarseness.
Notify your doctor If you experience new shortness of breath 24 – 48 hours after the injection or any signs of infection in the area of the injection, you should call your doctor right away at: 301-530-7303 or go to the nearest emergency room.