What are Stellate Ganglion Blocks?

Stellate ganglion blocks explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Stellate Ganglion Block DiagramA stellate ganglion block is a treatment approach for upper body pain that is caused by damaged ganglion nerves. The sympathetic chain consists of ganglion nerve bundles that run along the spinal cord and extend down the trunk of the body. The nerves extend to various parts of the body and control numerous unconscious functions such as heart rate as well as conscious biological processes. Ganglia are clusters of nerve endings called nexuses and essential ganglia are located throughout the sympathetic nervous system. A single network of these nerve endings has the ability to control sensations and movement.

Stellate ganglia, in particular, control blood circulation and the transfer of sensory information to the brain, chest, and upper body. If these nerves become irritated, inflamed, or damaged, signal transmission to the face, hands, arms, fingers, and chest may become disrupted. This type of disturbance leads to serious pain in these parts of the body.

Traditional treatments such as pain medication or opioids do not typically reduce the pain that is caused by damaged stellate ganglia. As a result, physicians generally recommend that patients receive injections that can block the pain signals from the affected nerve cluster. Reports indicate that a stellate ganglion block is an effective technique that provides significant relief from chronic pain.

How are Stellate Ganglion Blocks Performed?

Stellate Ganglion LocationA stellate ganglion injection involves delivering medication to the inflamed nerve cluster. Local anesthesia is first applied to the skin in the neck region and then an imaging device such as an X-ray, ultrasound, or fluoroscope is used to guide the thin needle that is inserted into the targeted region. Contrast dye is also injected before the anesthetic to help ensure that the needle will be properly placed and to make sure that the medication will be appropriately distributed to the affected ganglia.

After the correct placement is confirmed, either an anesthetic or steroid is injected. The medication disrupts the transfer of pain signals from the irritated or injured nerves in the ganglion. An alternative method entails inserting a catheter through a larger needle in order to administer the medication for several hours as a treatment for severe and persistent pain. In addition, a stellate ganglion block can be used as a diagnostic tool to pinpoint the nerve cluster that is causing the pain.

The risks associated with a stellate ganglion block are mainly due to how close the needle is placed to the esophagus and the vertebral artery. If the medication is accidentally injected into one of these structures severe side effects such as difficulty swallowing, chest discomfort, an aneurysm, or bleeding may develop. However, the use of imaging technology during the placement of the needle reduces these risks.

Additional side effects that may occur, but are rare, include numbness in the chest, vocal cord paralysis, respiratory problems, and nerve damage. Nasal congestion and droopy eyelids are the most common side effects, but they are temporary. 

Conditions Related to Stellate Ganglion Blocks

Stellate Ganglion Block ExplainedThe stellate ganglion is comprised of thoracic and cervical nerve endings. As a result, conditions that affect the hands, chest, arms, and face may occur when these nerve endings become irritated. Patients with a condition called complex regional pain syndrome, which is associated with pain in the hands or arms that is not proportionate to the injury, possible nerve damage, or pain in multiple areas, is usually effectively treated by a stellate ganglion block.

A stellate ganglion block is also an effective treatment for chronic headaches or facial pain. Patients suffering from chest pain or angina have also benefited from this procedure. Furthermore, this block has been used to treat hot flashes that are caused by menopause, breast cancer pain, and post-traumatic stress disorder. The approach has even demonstrated the ability to improve the symptoms of electrical storm syndrome, which is described as a continuous, irregular heartbeat that occurs due to blocked arteries in the heart.

Conclusion

A stellate ganglion block is an effective treatment approach that hinders the transfer of information from nerves that regulate the sympathetic nervous system. As a result, pain that was being experienced in the face, chest, or upper limbs decreases. This procedure is quick and minimally invasive and effectively treats various conditions and disorders. Rare side effects such as chest discomfort, vocal cord paralysis, bleeding, and damage to the vertebral artery or esophagus may occur. Despite these risks, stellate ganglion blocks are safe and patients report significant pain relief after receiving this form of treatment.

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References

  1. Toshniwal G, Sunder R, Thomas R, Dureja GP. Management of complex regional pain syndrome type I in upper extremity-evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study. Pain medicine (Malden, Mass.). 2012;13(1):96-106.
  2. Gadhinglajkar S, Sreedhar R, Unnikrishnan M, Namboodiri N. Electrical storm: Role of stellate ganglion blockade and anesthetic implications of left cardiac sympathetic denervation. Indian journal of anaesthesia. 2013;57(4):397-400.
  3. Shanthanna H. Utility of stellate ganglion block in atypical facial pain: a case report and consideration of its possible mechanisms. Case reports in medicine. 2013;2013:293826.
  4. Lipov EG, Navaie M, Brown PR, Hickey AH, Stedje-Larsen ET, McLay RN. Stellate ganglion block improves refractory post-traumatic stress disorder and associated memory dysfunction: a case report and systematic literature review. Military medicine. 2013;178(2):e260-264.
  5. Noma N, Kamo H, Nakaya Y, et al. Stellate ganglion block as an early intervention in sympathetically maintained headache and orofacial pain caused by temporal arteritis. Pain medicine (Malden, Mass.). 2013;14(3):392-397.
  6. Bhatia A, Flamer D, Peng PW. Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study. Canadian journal of anaesthesia = Journal canadien d’anesthesie. 2012;59(11):1040-1047.
  7. Narouze S, Vydyanathan A, Patel N. Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture. Pain physician. 2007;10(6):747-752.
  8. Siegenthaler A, Mlekusch S, Schliessbach J, Curatolo M, Eichenberger U. Ultrasound imaging to estimate risk of esophageal and vascular puncture after conventional stellate ganglion block. Regional anesthesia and pain medicine. 2012;37(2):224-227.