A stellate ganglion block is an injection used to relieve pain associated with the upper extremities. The stellate ganglion is a bundle of sympathetic nerves that supply the arms and hands.
Complex regional pain syndrome is a condition where trauma or injury to an upper extremity causes burning and severe pain. The stellate ganglion block is used to destroy a portion of the nerves that supply these extremities, so that pain signals cannot be transmitted to the brain.
A local anesthetic is used for diagnostic purposes, such as bupivacaine or lidocaine. For long-lasting pain relief and treatment purposes, a neurolytic agent is used, such as phenol or absolute alcohol.
The doctor will first numb the region using a very small needle and an anesthetic. You will feel a slight pinching sensation and mild burning. After the skin is numb, you will only feel pressure at the injection site, but some pain can occur during the procedure. If necessary, the doctor will give you a mild sedative to make you comfortable.
The stellate ganglion block injection only takes a few minutes. However, you must allow an hour for the entire procedure. When you arrive at the medical facility, you change into a gown. Then, a nurse will review the risks and benefits of the block and have you sign a consent form. In addition, you will be in the recovery room for 20-40 minutes after the injection.
You will be positioned on your back, and a nurse will monitor your blood pressure and oxygen using small devices. The doctor cleans the skin on the side of your neck, and numbs the skin with an anesthetic. Using x-ray guidance (fluoroscopy), the needle is inserted near the stellate ganglion nerves. Once position is confirmed, the medication is injected onto the nerves.
Immediately after the procedure, a nurse monitors you and evaluates your pain. Expect to have some drowsiness and soreness at the injection site. You are not permitted to drive for 24 hours, and should rest for the remainder of the day. Common side effects include temporary hoarseness, slight eye dropping on the injected side, and slight eye redness and tearing. This only lasts 1-4 hours.
This is hard to predict, as effectiveness varies from patient-to-patient. For some patients, the sympathetic nerves are destroyed, and pain relief is 100%. Repeat injections may be necessary if symptoms persist.
The procedure is very safe, but there are a few risks. While these rarely occur, they include:
Puncture of the dural sac (leak of spinal fluid)
Injury to blood vessels
No relief of pain
Patients who are allergic to anesthetics and neurolytic agents cannot have the stellate ganglion block. In addition, persons on blood-thinning drugs (Heparin, Coumadin, Plavix) should discuss holding these medicines 4-7 days before, and if this is not possible, the block cannot be done. Because x-ray guidance is used, pregnant women should not have this procedure.
In one clinical study, researchers found that the block significantly improve wrist range of motion for all patients. Another research study found that this block lasted for up to 34 weeks, and 76% of patients had pain relief.