FAQ’s on Stellate Ganglion Nerve Block in Philadelphia

To relieve pain of the upper extremities, the pain management specialist often uses a stellate ganglion block. The stellate ganglion is a bundle of nerves that transport pain signals from the shoulders, arms, and hands.

How does the stellate ganglion block work?

This block has three functions:

  • Diagnostic – The pain doctor can diagnose if or not the pain is related to the sympathetic nerves.
  • Prognostic – This means the doctor determines if a more detailed procedure will be effective, such as neurolysis, chemoneurolysis, or radiofrequency ablation.
  • Therapeutic – This means the procedure is used to treat painful conditions.

How long does it take to perform a stellate ganglion block?

The procedure only takes around 10 minutes, but the patient will be at the medical facility for about one hour. This include preparation time, the actual procedure, and recovery observation time.

What medications are used during the stellate ganglion block?

For diagnostic blocks, the pain management specialist uses local anesthetics, such as bupivacaine and lidocaine. A mild sedative may be required for the procedure. Other medications include contrast dye and an antiseptic cleansing solution.

What conditions can be treated with the stellate ganglion block?

This block is used for:

  • Acute herpes zoster (shingles) pain
  • Raynaud’s syndrome
  • Complex regional pain syndrome (CRPS)
  • Vascular insufficiency
  • Phantom limb pain
  • Cancer pain
  • Post-herpetic neuralgia
  • Neuropathic pain
  • Atypical facial pain
  • Trigeminal neuralgia

How do I prepare for the procedure?

Before the procedure, the doctor will discuss the pros and cons, and ask you to sign a form of informed consent. Because IV sedation is used, you must arrange to have someone drive you home. Do not eat or drink six hours before the procedure, but necessary medications can be taken with sips of water. Inform the medical staff of any blood-thinning medications you are taking, as these must be held for several days.

How is the stellate ganglion block done?

You will change into a gown, and a nurse will place an IV catheter in your arm. Monitoring devices are used to assess blood pressure, heart rate, and oxygen level. This outpatient service is minimally invasive and done using fluoroscopy (x-ray guidance). The skin at the side of the neck is cleansed with a special solution, and a numbing agent is given. The needle is positioned near the stellate ganglion nerves, and a long-acting anesthetic is injected onto the nerves. The doctor may also use a corticosteroid medication.

What occurs after the procedure?

After the stellate ganglion nerves are injected, you will feel your arm getting warm, slightly numb, and tingling. These side effects are temporary and resolve in a few minutes. Many patients also report temporary drooping of the eyelid on the affected side, as well as hoarseness and eye watering. A nurse will monitor you for 20-30 minutes. You should rest for the remainder of the day, and gradually return to usual activities.

Does the stellate ganglion block work?

In a recent clinical study, researchers examined the efficacy of the stellate ganglion block for patients with CRPS. The found that almost half of the participants reported complete symptom relief, and an additional third reported partial symptom relief. The overall success rate was 76%, with pain relief lasting longer than 16 weeks.

What complications are associated with the stellate ganglion block?

Overall, the procedure is safe with few risks. However, there is a chance of nerve damage, infection, bleeding, and no pain relief. Patients who have an active infection cannot have the procedure.

Resources

Ackerman, W.E. & Zhang, J.M. (2006). Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome. Southern Medical Journal, 99, (10).

Yucel I, Demiraran Y, Ozuran K, & Degrimenci E (2009). Complex regional pain syndrome type I: efficacy of stellate ganglion blockade. J Orthop Traumatol, 10(4): 179-183.