• Stellate Ganglion Block

    1. What is a stellate ganglion block?

    A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck. It is typically ordered by your doctor for pain located in the head, neck, chest or arm that is caused by sympathetically maintained pain (complex regional pain syndrome), causalgia (nerve injury), herpes zoster (shingles) or intractable angina. Stellate ganglion blocks are also used with circulation problems, particularly Raynaud's or complex regional pain symdrome (CRPS), to see if blood flow can be improved.

    Stellate ganglion blocks may be of therapeutic or diagnostic value. One of three things will happen:

    1. The pain does not go away, but there is other evidence of a sympathetic block, meaning the pain is not responsive to sympathetic blocks. This is of diagnostic value.
    2. The pain does not go away and there is no good evidence of a sympathetic block, meaning the block is a technical failure.
    3. The pain goes away after the injection and stays away longer than the life of the local anesthetic, meaning the block was of therapeutic value.

    The procedure will most likely have to be repeated to achieve a long-lasting benefit. The spacing of injections will be based on how long the pain relief lasts between injections. Usually, you will experience a longer benefit following each subsequent injection.

    Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.

    2. What are the risks of the procedure?

    The risks of the procedure-though rare-include seizure (if the medication is injected into a blood vessel), pneumothorax (collapsed lung), brachial plexus block (numb arm that lasts for hours), spinal or epidural block (temporary weakness or numbness from the neck down), allergy to the medication used, nerve damage and bruising at the injection site.

    There are some expected changes that result from blocking the sympathetic nerves. These changes last for the life of the local anesthetic (approximately four to six hours). They include drooping of the eyelid, "bloodshot eye," a stuffy nose, and a temperature increase on the injected side. You may also experience hoarseness.

    3. Will the injection hurt a lot?

    The doctor has to press on your neck to locate the area to be injected. Many patients find this awkward and somewhat uncomfortable. The injection itself is done using a very small needle. The local anesthetic stings/burns while being injected.

    4. What happens during the actual procedure?

    After you sign a consent form and your blood pressure is checked, an intravenous will be started. Skin temperature monitors will be placed on both of your hands. You will be asked what your pain score is on a scale of 0 to 10.

    The procedure will be done with you lying on your back with a sheet rolled up between your shoulder blades. Your neck will be cleaned with an antiseptic. Then, the doctor will press on your neck to identify where to place the needle. At this time, he will ask that you try not to talk, cough or swallow. When the needle is in the correct place, the medicine (local anesthetic) is injected through the needle. The needle is then removed and the procedure is complete. This usually takes about 5 to 10 minutes. If your pain is usually in your head, you will remain lying down. If your pain is usually in your arm, you will be asked to sit up so the medicine spreads down. The medicine can take 10 to 20 minutes to take full effect. You will be watched during that time. Your doctor will be checking to see if the expected changes take place, as well as to see what effect, if any, there is on your pain.

    5. What happens after the procedure?

    You will be observed for 15 to 20 minutes. Your pulse and blood pressure will be monitored during this time. Your intravenous will be removed, and you will be discharged when you are ready and your ride is present. You may have some local tenderness from the needle, which ice will help relieve. You can also resume taking your normal pain medications.

    6. Will I have any restrictions after the procedure?

    Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home, or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of the procedure. Otherwise, you may do whatever you feel up to doing.

    7. For what reasons should I call the Pain Management Center after the injection?

    You should call us immediately at 781-744-5090 if you experience any of the following:

    • Severe back pain that is not relieved with medication and ice
    • Prolonged, new numbness or weakness of your arms
    • Signs of infection in the area of injection

    Things to Do Before the Procedure

    • Any dietary restrictions will be discussed on the day the procedure is booked.
    • Take all of your medications as scheduled on the day of the procedure, unless directed otherwise.
    • Think of any questions for us and write them down.
    • Make the nurses and doctors aware of any new changes in your medical condition.
    • Before you come in, let us know if you are taking any blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal) or anti-inflammatories.
    • Please remember to arrange for an adult to drive you home.
  • Make an Appointment

    (781) 744-5090