Stellate Ganglion blocks

Stellate Ganglion blocks

A stellate ganglion block is a minimally invasive, outpatient procedure used to treat a multitude of chronic pain syndromes in the face, head, neck, arm and chest. At Advanced Pain Consultants, Dr. Pasi may offer this procedure to patients whose pain is unresponsive to pain medications, lifestyle changes or other types of conservative treatments.

During this procedure, a small amount of pain-relieving medication (usually a combination of a local anesthetic and steroid) is injected into the part of the neck where the stellate ganglion lies. The stellate ganglion is a bundle of nerves found at the level of the sixth and seventh cervical vertebrae (the last vertebra of the neck) and is part of the sympathetic nervous system (SNS). The SNS prepares the body to react to stressful situations, which includes regulating heart rate, blood pressure, pupil dilatation, sweating and digestion, etc.

Trauma, infection or other conditions can cause the sympathetic nerves to become overactive, which can lead to various chronic pain syndromes. Blood flow can be affected, resulting in painful symptoms in the hands or feet; they may hurt, burn, feel cold, or be tender to touch. Headache, neck and shoulder pain can also occur. The goal of a stellate ganglion block is to “interrupt” or “block” the signals of the sympathetic nervous system to the brain, in hopes of reducing or eliminating pain.

A sympathetic nerve block can be considered both a diagnostic and therapeutic procedure. If pain is substantially improved after the initial injection, then a diagnosis of sympathetic nerve pain can be established. Additional, “therapeutic” blocks may be repeated as the pain continues to sequentially diminish.

Who can benefit from a stellate ganglion block?

The stellate ganglion block is most often used with patients who suffer from pain syndromes affecting the head, face, neck, arms or chest, who have not responded well to other, more conservative treatments. This therapy may also be used to control the pain and swelling associated with circulatory disorders and nerve injuries.

This procedure can be used to relieve pain associated with many different conditions, including:

  • Complex regional pain syndrome (sympathetic mediated pain in the upper extremities).
  • Phantom limb pain or discomfort.
  • Reflex sympathetic dystrophy (tenderness, swelling and burning pain in the extremities).
  • Herpes neuralgia (post shingles nerve pain).
  • Blood vessel spasms.
  • Raynaud’s syndrome (a narrowing of small blood vessels in hands/feet).
  • Intractable angina (severe chest pain).
  • Scleroderma (hardening and tightening of the skin and connective tissues).
  • Trigeminal neuralgia (facial pain affecting the fifth cranial nerve).
  • Vascular problems of upper limbs.
  • Paget’s disease (abnormal bone growth).
  • Post-radiation neuritis (nerve damage after radiation).
  • Causalgia (injury to the nerves).

Not every patient suffering from one of the above conditions will be a candidate for this kind of pain control. Patients who are allergic to anesthesia, pregnant or taking blood-thinning medications, or have an active infection, uncontrolled diabetes, glaucoma, heart disease or a bleeding disorder may or may not be eligible; these conditions should be discussed with Dr. Pasi prior to treatment.

How is the procedure performed?

A stellate ganglion block injection can be performed in our in-office surgical center. The entire process including check-in, preparation, surgery and recovery takes about 1 to 1½ hours. (The injection itself typically only takes around 15 to 30 minutes, but the additional time is necessary to ensure a safe and effective procedure.)

Dr. Pasi starts by cleansing the skin over the area to be injected. Next, she will inject a local anesthetic into the treatment area to numb it. She will then insert a fine needle near the stellate ganglion, using x-ray guidance to ensure proper placement and positioning of the needle. Contrast dye may also be injected (unless the patient has allergies to iodine) to confirm that the needle is in the proper location. Once this occurs, the medication (usually a combination mixture of a steroid and local anesthetic) will be slowly injected. This medication spreads around and bathes the nerves. The needle is then removed and a sterile dressing is applied. The patient will be taken to the recovery room, and will be released to go home after a brief observation period.

Patients often report pain relief immediately after the injection, but it typically returns a few hours later as the local anesthetic wears off (the longer-lasting pain relief will occur once the steroid takes effect). There may be some minor irritation at the injection site, but this will usually be gone the next day.

Expected outcome

While stellate ganglion blocks don’t work for everyone, they are effective at relieving pain for the vast majority of patients. The steroid generally begins to take effect 2 to 3 days after the procedure. After one injection, patients typically experience 1 to 3 days of pain relief (although some patients have several weeks or more of relief). Symptoms may be only partially relieved, or totally. The extent of relief and how long it lasts is different for each patient, depending on the person’s individual response to the medications and the severity of the condition being treated.

Many patients will require a series of three or more injections, over several weeks or months, before they benefit from the full effects of this type of therapy. This is why, if after the first injection, pain relief only lasts a day or two, that does not mean the treatment was a failure, but rather it indicates that multiple injections will likely extend the relief as there is a cumulative benefit to this type of treatment. Typically, with each injection, there is a progressive lessening of symptoms and the duration of relief increases. When the series is completed, anywhere from 3 to 12 months of pain relief may have been achieved.

To further improve results, the stellate ganglion block injections may be followed up with further neuroablative procedures or spinal cord stimulator implant surgery in future. In some cases, other treatments, such as radiofrequency ablation can be applied to the stellate ganglion to extend the pain relief.

Is a stellate ganglion block right for you?

If you are suffering from chronic pain in your head, neck, upper arm or chest and it hasn’t responded well to other treatments, please Advanced Pain Consultants to see what we can do for you. After a physical evaluation and medical history, Dr. Pasi will be able to determine if your pain is related to the sympathetic nerves and if a stellate ganglion block can help. To book your appointment, please call (919) 510-7901. We look forward to serving you and helping you achieve the pain relief you need.