Stellate Ganglion

The stellate ganglion is a plexus of nerves that sit in the cervical spine in the neck. This network of nerves branches out into the arms and fingers to provide sensation as well as control in the upper extremities. It is part of the sympathetic nervous system and is responsible for a variety of unconscious reactions in the body, most notably the fight or flight response. The sympathetic nervous system also controlled various functions such as heart rate, blood vessel, and sweating. When patients have abnormal nerve responses to pain that leads to chronic burning or tingling sensations, an injection at the stellate ganglion on can help with the symptoms.

The Stellate Ganglion Block Procedure

To begin the Stellate Ganglion Blockprocedure, the patient is placed on a comfortable bed laying down.  A special type of x-ray called a fluoroscope is commonly used so that the doctor is able to see the internal structures of the spine in real time while performing the block. This helps to ensure accurate placement of the needle and medication. In most cases, a patient will lay on their stomach for the procedure, on the bed of the fluoroscope.

Some practitioners may give the patient a mild IV sedative. The skin on the neck is cleaned thoroughly to keep the environment sterile. A topical anesthetic is applied before the needle is placed in the spine. The needle is very small and thin. The doctor will use the imaging to guide its placement into the specific area of the sympathetic nerve fiber. A dye is injected first, to ensure proper placement. Medication is then added, including anesthetics and steroids. Although it does not always occur, an increase in the surface temperature of the arms is a good indicator that the block has been administered correctly.

Most patients notice an immediate change that can include pain relief or a warming sensation in the arms. After the procedure, patients should take it easy for the remainder of the day but can return to normal working activities the next day. The anesthetic effects will wear off within a day. If a steroid has been administered it will take about 2-3 days before the patient is able to feel effects from it. Most patients need multiple rounds of the nerve block before reaching sufficient pain relief.

Conditions that may warrant a Stellate Ganglion Block

A nerve block may be necessary for conditions that involve pain or swelling in the arms. Additionally, conditions involving issues with blood circulation and oxygen delivery to tissues (vascular insufficiency) may benefit from a nerve block. Typically the earlier in the disease that a nerve block can be utilized, the more effective the intervention is.

• Reflex sympathetic dystrophy (RSD) and Complex regional pain syndrome (CRPS) are used interchangeably to describe the same condition. This is a rare condition where patients experience severe, chronic pain and swelling in one or multiple limbs. It is not yet fully understood although it seems to be triggered by an initial event (such as a traumatic injury, surgery or stroke). It is thought to be a consequence of inflammation and overstimulation of the sympathetic nervous system.
• Shingles(also called herpes zoster) is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. After an episode of chickenpox, the virus remains in the body and can become reactivated later in life. This involves a very painful rash. If the rash is localized to regions on of the arms, a nerve block can help alleviate some of the pain associated with the rash. It may also help with residual pain after the rash has cleared (indicating overstimulated nerve damage).
• Vascular Insufficiency occurs when blood flow is reduced to a specific area. Blood carries oxygen to tissues and when the circulation is limited, tissues will eventually become damaged. The blood flow reduction can have a variety of causes including Raynaud syndrome, frostbite or diabetes.
• Peripheral neuropathy (PN) involves damage to peripheral nerves. Pain, numbness or tingling sensations accompany weakness and can potentially affect balance and gait, as PN most often affects the hand and feet. This nerve damage has a variety of potential causes including diabetes, immune issues, trauma, viral infections and side effects of medication, among others.
• Phantom Limb Pain occurs when an arm or leg is amputated but the patient continues to feel sensations (pain) at though it is still there. While it was once thought to be psychological, it is now understood that nerve impulses originating from the spinal cord are being sent to the brain and are interpreted as pain. It’s is also theorized that the brain undergoes some chemical alterations as a result of coping with an amputation and this can contribute to the phantom pain.

Patients that should not have either procedure include those:

• Allergic to the type of medications used
• Using blood thinners as they are at increased risk of internal or extensive bleeding
• With any active bacterial or viral infection
• Experiencing an uncontrolled chronic condition such as diabetes or heart disease

Possible Side Effects

As with any medical procedure, there are possible side effects to consider. Most are mild and the more severe side effects are extremely rare.

• Pain at the injection site
• Infection at the injection site
• Internal infection in the surrounding tissue
• Bleeding
• Bruising
• Misplacement of the injection (blocking or damaging the wrong nerve)
• Overdose of anesthetic
• Unintentional damage to nerves
• Permanent nerve damage or paralysis

Conclusion

A stellate ganglion block is a treatment option available for those suffering from various pain and vascular issues affecting the arms. While minimally invasive, these procedures are not generally used as the first-tier treatment option in pain management.

Treatment options for neuropathic extremity pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise.  Individual programs may include nerve blocks, physical therapy, occupational therapy and other modalities which may boosts the body’s natural ability to heal.

If your pain does not resolve after a brief period, contact us so that we may help diagnose the problem and treat the underlying cause.  Do not let pain persist or else it may become chronic.