What is a stellate ganglion block?
A stellate ganglion block is an injection of local anesthetic (numbing medicine) to block the sympathetic nerves located on either side of the voice box in the neck. An injection at these nerves may reduce symptoms such as pain, swelling, color, sweating changes in the upper extremity and may also improve mobility. This injection is typically ordered by your doctor for pain located in the head, neck, chest or arm caused by sympathetically maintained pain (reflex sympathetic dystrophy), causalgia (nerve injury), herpes zoster (shingles), or intractable angina (pain related to decreased blood flow to the heart). Stellate ganglion blocks are also used to see if blood flow can be improved in those patients with circulation problems related to vascular disease.
Stellate ganglion blocks may be therapeutic (to relieve pain) and/or diagnostic (to determine the source of your pain). If effective, your doctor may recommend a series of these blocks 1-2 weeks apart which may help give you more long term pain relief.
What are the risks of the procedure?
The risks of the procedure, though infrequent, may include seizure - if the medication is injected into a blood vessel - bleeding, pneumothorax (collapsed lung), brachial plexus block (temporary numb arm that lasts for a few hours), spinal or epidural block (temporary weakness or numbness from the neck down), allergic reaction to medication, nerve damage, and bruising at the injection site.
There are some expected changes that result from blocking the sympathetic nerves. These changes are temporary and may last about 4 - 6 hours. Such changes include the following symptoms on the same side as the injection: drooping of the eyelid, bloodshot eye, stuffy nose and a temperature increase in the arm. You may also experience some hoarseness.
Will the injection hurt a lot?
The doctor has to press on your neck to locate the area to be injected, and many patients find this somewhat uncomfortable. The injection itself is done using a very small needle, but the local anesthetic may sting for a short time as it goes in.
What happens during the actual procedure?
After signing a consent form and checking your blood pressure, an intravenous (IV) line will be started. Skin temperature monitors will be placed on both your hands. You will be asked what your pain score is on a scale of 0 - 10. The procedure will be done with you lying on your back with a pillow placed under your shoulder blades. Your neck will be cleansed with an antiseptic soap. The doctor will press on your neck to identify where to place the needle. At this time, we'll ask that you try not to talk, cough, or swallow. This is very important as these activities may cause the needles to move.
When the needle is in the correct place, the anesthetic medication is slowly inserted through the needle. This usually takes about 5 – 10 minutes. The needle is removed once the procedure is complete. If your pain is usually in your head, you will remain lying down; if your pain is usually in your arm, you’ll be asked to sit up so the medicine spreads downward. The medicine can take 10 – 20 minutes to take full effect.
What will happen after the procedure?
You will stay in our recovery area and your pulse, blood pressure and temperature in the affected arm will be monitored for a period of time, usually about 40-60 minutes. You will be offered juice/soda and graham crackers. You will be given verbal and written discharge instructions, and may go home with your driver after your doctor authorizes discharge.
How will I feel after the injection?
Your neck may feel tender after the injection, and one eye may be droopy. This could affect your sense of balance. Your voice may become hoarse and your swallowing may be impaired for a short time. You will be instructed not to eat or drink anything for four hours after the procedure, until your ability to safely swallow has returned. All of the above symptoms are temporary and will return to normal once the anesthetic has worn off. It is important that you keep track of the amount of pain relief you receive as well as how long the pain relief lasts.
Will I have any restrictions on the day of the procedure?
You may not drive for the remainder of the day. You will be instructed not to eat or drink anything for four hours after the procedure, until your ability to safely swallow has returned. Your regular diet and medications may be resumed after this time period. You may resume normal activity the day after the procedure.
When should I call the Pain Management Center?
We would like speak to you the day after your procedure regarding your response. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain score, and if you are experiencing any problems. If you experience severe pain, new numbness or weakness of the arm, a temperature of 100.5 or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call the Pain Management Center right away at 410-448-6824 during business hours, and 410-448-2500 after hours to have the pain management physician on call paged to your number.