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Stellate ganglion block: effects

Also called a cervicothoracic sympathetic block and used primarily to treat Complex Regional Pain Syndrome. It has also been used to treat refractory angina, phantom limb pain and vascular insufficiency (such as Raynaud’s or frostbite), hyperhydrosis and other things. The stellate ganglion is formed by the fusion of the inferior cervical and first thoracic sympathetic ganglia anterior to the vertebral body of C7. It lays under the SCM/carotid, above the lung, lateral to the esophagus/C7 vertebral body/thoracic duct and in front of the vertebral art/brachial plexus.

The block is done supine, usually at C6 between the trachea and the carotid, at the level of the cricoid. Blocking at C7, it normal anatomical location, risks nicking the pleura. The goal is to hit the C6 transverse process (Chassignac’s tubercle) then direct med/inf toward the C6 body. Once there, the needle is withdrawn 1-2 mm and contrast is injected. You are hoping for contrast spread cephalad and caudad between tissue planes. Pooling means you’re likely in the muscle (longus colli) and immediate disappearance of contrast means you’re in a vessel. Usually a very small local/epi 0.5 cc test dose is advocated (although be aware that even this amount straight into the vertebral or carotid artery can cause seizures). Ten or 15 ml with frequent aspiration is then injected. Horner’s syndrome (ptosis, miosis, anhydrosis) is proof of a job well done. Other side effects seen are hoarseness, (recurrent laryngeal nerve) and elevated hemidiaphragm (phrenic nerve).

Complications are rare but with so many important neighbors, you can imagine the list is long: hematoma from carotid/IJ trauma, brachial plexus injury, pneumothorax, hemothorax, chylothorax (thoracic duct injury), esophageal perforation (this may be more common than we think but usually of no significance unless it leads it infection/abcess), intravascular/intrathecal/epidural injection, meningitis.

Stellate Ganlgion Block

  • Indications: CPRS. Also angina, phantom limb pain, vascular insufficiency, hyperhidrosis
  • Anatomy: Inferior cervical + T1 sympathetic ganglia @ C7. Lays under the SCM/carotid, above the lung
  • Side Effects: Horner’s (intentional), hoarseness (RLN), eleveated hemidiaphragm (phrenic)
  • Complications: hematoma, brachial plexus injury, pneumothorax, esophageal perforation, intrathecal/epidural/intravascular injection