Stellate ganglion block has a diagnostic and therapeutic value. It is applied to treat various painful conditions of the head, neck, upper extremities and upper chest. If the diagnostic block with local anaesthetic brings satisfactory analgesic result, then follows radiofrequency neurolysis of the ganglion.
-Acute pain due to herpes zoster
-Complex Regional Pain Syndrome I,II (CRPS I, II)
-Cancer pain of head, neck, upper extremities
-Vascular diseases of upper extremities
-Hyperhidrosis of face and upper extremities
-Phantom upper limb painP
The stellate ganglion is formed at the point where the inferior cervical ganglion meets the first thoracic ganglion, at the anterior surface of the 7th cervical vertebral body. The ganglion is very closely adjacent to the carotid sheath, vertebral artery, phrenic nerve and recurrent laryngeal nerve. At the C7 spine level the vertebral artery courses anterior to the stellate ganglion, while at the C6 spinal level it courses posterior to the ganglion.
Stellate ganglion block can be performed with various techniques. One of the most common ones is the anterior approach at C6 spine level. Relatively large amounts (5-20ml) of local anaesthetics are injected about 2 mm above the Chassaignac tubercle. Such a large anaesthetic volume is needed so that the drug can be diffused downwards, where the stellate ganglion lies. The approach can also be conducted at C7 level by applying smaller amount of local anaesthetic. However, there is the risk of vertebral artery puncture that might provoke pneumothorax.
The block can be performed with:
- blind method and hand palpation of the anatomical guiding points
- fluoroscopic guidance
- ultrasound guidance
The patient is placed in the supine position with a pillow under the shoulders so that the neck is slightly overextended and the mouth slightly open. After the region has been locally sterilised, the physician sets aside the patient’s sternocleidomastoid muscle and carotid and palpates the Chassaignac tubercle (using fingers of one hand). Local skin anaesthesia is applied at the puncture point and a needle is inserted and advanced under fluoroscopic guidance until it comes in contact with the tubercle. The proper position of the needle is confirmed by infusing contrast medium and acquiring anteroposterior and lateral fluoroscopic images. The needle is withdrawn about 2mm and a slow and controlled infusion of the drug solution follows.
Some patients develop Horner syndrome immediately after the stellate ganglion block. The symptoms of this syndrome are blepharoptosis, miosis (pupil shrinking) and anhidrosis of the blocked side. These symptoms subside after the local anaesthetic action has passed. The technique is completed within about 15 minutes.
There are no evidence-based studies for the efficacy of the stellate ganglion block. However, there are case reports and small clinical trials reporting impressive results in many patients.
1. PAIN PRACTICE JOURNAL
2. BONICA`S MANAGEMENT OF PAIN
3. PAIN PHYSICIAN JOURNAL
4. INTERVENTIONAL PAIN MANAGEMENT BOOK
5. MANUAL OF RF TECHNIQUE (GAUCI)
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