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Stellate Ganglion Blocks

A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck. It is typically used for pain located in the head, neck, chest or arm that is caused by:

  • Sympathetically maintained pain (reflex sympathetic dystrophy)
  • Causalgia (nerve injury)
  • Herpes zoster (shingles)
  • Intractable angina

Stellate ganglion blocks are also used to see if blood flow can be improved in circulation problems typically from Raynaud's disease or CREST syndrome (limited scleroderma).

Stellate ganglion blocks may be therapeutic and/or diagnostic. One of three things may happen:

  • The pain does not go away, and there is other evidence of a sympathetic block. If the pain is not responsive to sympathetic blocks, this is of diagnostic value.
  • The pain does not go away, and there is not good evidence of a sympathetic block, indicating that the block is a technical failure.
  • The pain goes away after the injection and stays away longer than the life of the local anesthetic, indicating that 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).

What are the 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 four to six hours). They include drooping of the eyelid on the injected side, a 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 procedure cannot be performed if you have an active infection, flu, cold, uncontrolled cough, fever, very high blood pressure or if you are on blood thinners. For your safety, please make your doctor aware of any of these conditions.

Will the injection hurt a lot?

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.

What happens during the actual procedure?

After you sign a consent form and your blood pressure is checked, an intravenous will be started. Skin temperature monitors will be placed on both your hands. You will be asked to rate your pain 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. 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 five to 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 to 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.

How will I feel after the injection?

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 in a sling until sensation returns, usually four to six 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.

Will I have any restrictions on the day of the procedure?

You may not drive for the remainder of the day after the procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. For your safety, the procedure will be cancelled if you do not have a responsible adult with you.

Be careful swallowing after the injection (take sips of water first), especially if you experience hoarseness.

For what reasons should I call the Center for Pain Medicine after the injection?

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 the Center for Pain Medicine at 617-732-9060.

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