Raj N. Sureja, MD
As an Interventional Pain Management Specialist, I have injections that I often use for dual purposes: 1) for diagnostic reasons – to find or pinpoint a source of pain or to confirm that diagnosis and 2) to treat pain and inflammation caused by a condition, injury, or illness. Steroid injections are often used this way and nerve blocks are as well, especially by orthopaedic and pain management physicians. In this article, I will discuss the Stellate Ganglion Block, why we use it as a diagnostic tool and how it is used as a treatment for some conditions that commonly affect the head, neck, chest, or arms.
The stellate ganglion is a cluster of nerves located on either side of the trachea in the cervical (neck) spine which is a part of the sympathetic nervous system. These nerves help to control the transmission of pain signals and help regulate respiration and circulation in the head, neck, chest, and arms. The stellate ganglion is proximate to the carotid artery, the subclavian artery, and the vertebral artery, and plays a role in enervating the heart.
When a patient is experiencing symptoms or pain in the head, neck, chest and/or arms and they come to my office for a diagnosis, I will do a complete physical examination, review their medical history, ask lots of questions, and look at the diagnostic tests that other physicians have ordered. I may order a stellate ganglion block when I suspect a diagnosis of or want to treat the following:
- RSD (Reflex Sympathetic Dystrophy) aka CRPS (Chronic Regional Pain Syndrome)
- Herpes Zoster or Post-herpetic neuralgia
- Peripheral Neuropathy
- Phantom limb pain
- Angina pain
- Chronic post-surgical pain
There are many other conditions for which a SGB can be ordered, but they are conditions which I do not treat in my practice, such as PTSD, Hyperhidrosis (profuse sweating) or scleroderma (hardening of the skin). The goal of the SGB will be to discover if; 1) the pain is reduced after the injection = therapeutic value or 2) the pain is not reduced, but there is evidence of a sympathetic block = diagnostic value or 3) neither the pain is reduced, nor a sympathetic block is evidenced = technical failure. All these are helpful in determining the next steps in both diagnosing and/or treating the patient.
Because of the difficulty of the procedure due to the stellate ganglion’s location in the neck, I typically refer my patients to a hospital-based pain management physician who specializes in doing this procedure. There are risks and complications to be aware of, which are medication allergies, infection at the injection site, seizures, pneumothorax, nerve damage, numbness, weakness, and bruising.
Done as an outpatient procedure, the patient is either placed in a reclined or flat position, given IV sedation to relax them, and then the patient’s neck is cleansed for the procedure and draped. The physician will inject numbing medication into the neck and then will inject contrast dye into the area where the stellate ganglion is – using live x-ray, called fluoroscopy. This is so the SG can be precisely pinpointed for the next injection, which is the numbing medication.
At this time the patient will remain lying or will be place in a sitting position, depending on the location of their pain, and their vital signs will be closely monitored. They may feel immediate, some or no pain relief, one arm may feel warm, one eyelid may begin to droop (ptosis), and the same eye may become bloodshot. The patient may experience hoarseness when they try to speak. These side effects may come on quickly or they may develop over the next hour or so.
After being monitored for about 20-30 minutes, the patient will have their IV removed and will be discharged to go home with a companion or driver. The patient must have someone to drive them home, no exceptions. Patients are cautioned about drinking during the first several hours after their SGB as they may have difficulty swallowing and should only take small sips of water at first.
Patients are advised to take it easy for 24 hours after their SGB, with no heavy lifting or activity. They should expect some soreness at the injection site, which can be intermittently iced if there is a barrier between the icepack and their skin. Tylenol can be taken for pain. The patient should watch for any redness, heat, swelling, bleeding, or pus at the injection site that may indicate an infection. A temperature of over 101.5° is of enough concern to send the patient to their physician or to the ER to be checked out. Obviously, any neurologic issues or other complications that arise should promptly be reported to your physician for triage.
It is important that my patients track how they feel for 24-48 hours after their SGB by keeping a pain diary. This tool will help us when we follow-up after the injection to decide on the best course of treatment for their condition or next steps in the diagnostic process.
Make an appointment with Dr. Sureja or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.