Stellate Ganglion Block Injections
Stellate ganglion blocks are injections are used in the neck, usually at the C6 or C7 vertebral body, and have both diagnostic and therapeutic values. Some of the pain syndromes that the stellate ganglion block can help include: shingles, intractable angina, sympathetically-maintained pain syndromes, complex regional pain syndromes (type 1 and 2), phantom limb pain, and causalgia. Other problems that can be helped with the stellate ganglion block include, hyperhidrosis (excessive perspiration) of the face and upper extremities, PTSD, hot flashes, arterial insufficiency, Raynaud's phenomenon, and scleroderma.
Utah Stellate Ganglion Blocks Treatment
A stellate ganglion block can be preformed using a number of different methods. One of the more common ways is to perform it at the C6 level. When done in the C6 level, a relatively large volume (5-20ml) of medication is injected 2mm superficial to the C6 tubercle. When this is done, the solution will spread downward to reach the stellate and upper thoracic ganglia. The procedure can also be done at the C7 level with a smaller volume of medication, but this increases the likelihood of vertebral artery injection or collapsed lung.
Another possible approach is the posterior paravertebral approach. The patient will be asked to lie on their back with their neck slightly extended, rotate their head to the side opposite the block and to keep their mouth open. Using fluoroscopic guidance, the doctor will insert the needle into the ganglion, ensuring proper placement with the use of contrast dye. If the procedure is successful, repeated injections will be recommended. Radiofrequency ablation is also a possible follow up that will have longer-lasting pain relief. After the procedure, the doctor will ask the patient to sit up in order to facilitate the spreading of the anesthetic.
Risks and Benefits
Risks involved with stellate ganglion blocks are minimal but, as with any procedure, there are theoretical complications. Most result from the misplacement of the needle and can include nerve damage, bleeding, collapsed lung, or esophageal perforation. Omega reduces these risks by using fluoroscopic guidance and contrast dye. Other potential complications include drug allergy, seizure, brachial plexus block (numb arm on the side of the injection), spinal or epidural block, hoarseness, and shortness of breath. The stellate ganglion block can be very beneficial to patients with a number of ailments, and the procedure is minimally invasive. The most common side-effect is a group of symptoms known as Horner's Syndrome which includes drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block was preformed on. These symptoms tend to wear off as the anesthetic wears off (about 4-6 hours).
When a stellate ganglion block is performed, there are a few outcomes that will help determine the next step in a patient's pain relief plan. These include:
1. The pain is gone or greatly improved and remains that way for longer than the duration of the anesthetic. If this happens, the doctor will see that the block had therapeutic value and will consider this when working on the patients continued treatment.
2. The pain is unchanged, but there is evidence of a sympathetic block. This has diagnostic value for the physician. It will tell them that the patient's pain is not responsive to a sympathetic block. Therefore, other treatments will be tried to relieve the patient's pain.
3. The pain is unchanged and there is no evidence of a sympathetic block. This indicates that the procedure was a technical failure
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