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Stellate Ganglion Block

What is the Stellate Ganglion?

The stellate ganglion is a small swelling towards the top of the chain of nerves called the sympathetic chain, that runs along the length of the spine.  The stellate ganglion lies level with the lower part of your larynx ("voice box") to the side of the neck, just on the front of the 6th vertebra in your neck.  The sympathetic nerves that pass through this ganglion carry the nerve impulses which control the diameter of blood vessels in the arm, head and face and sometimes activity in these nerves can be involved in certain types of nerve pain.  Stellate ganglion block with local anaesthetic is sometimes used to try to relieve these pains, or as a diagnostic procedure.

Where is the injection carried out?

You will be asked to attend the Day Surgery Unit for half a day (morning or afternoon) On the day you will be greeted by a nurse who will look after you until you go home. You may be asked to change into a gown and will be taken to one of the operating theatres for the procedure. 

How is the injection done?

You will be asked to lie on your back on a special table that allows us to use an X Ray machine to guide the injections.  The dose of XRays used is tiny: the machine intensifies a very small XRay dose in a similar way to army night vision goggles.  X-ray pictures are taken throughout to ensure the needle is in the correct area.  Alternatively, on occasions an ultrasound machine is used to guide the injection.

The skin overlying the ganglion is sterilised and a small amount of local anaesthetic is injected with a tiny needle to numb the skin.  Following this a fine needle is placed down onto where the ganglion lies.  Once correct position is confirmed a small amount of local anaesthetic and occasionally steroid is injected.  

The steroid acts only around the area it is injected into and does not have the same effects as taking long-term steroids.

Does it hurt?

You do not need a general anaesthetic for this procedure.  Very occasionally there can be some discomfort during the procedure but the doctor will ensure pain is kept to a minimum by using local anaesthetic.   You can sometimes also get a sensation of pressure as the local anaesthetic goes in.  Once the procedure is over you may have some tenderness over the injection site but no worse than after any other type of injection.  Following the procedure you will often have a feeling of a stuffy nose and sometimes some flushing of the face and arm on the side of the injection, as well as temporary drooping of the eyelid and perhaps a husky voice.  These changes are common and indeed many of them confirm that the injection is working well. 

How long will it all take?

Although the procedure itself usually only takes 10-15 minutes you will be asked to stay for up to an hour or so after the injection in the Day Surgery Unit before going home.

At home:

You may move around freely at home unless you have been advised to the contrary by a member of staff. Indeed, the patients who do best after this procedure are normally those who make use of the pain relief from the procedure to increase the amount of activity and exercise they do. You do not need to do any specific back exercises unless you have been instructed to do so.

Possible complications:

  • You may have mild discomfort at the site of the injection; this should last no longer than 48 hours. In a number of patients it can make your symptoms worse for about a week.
  • Very rarely you may get a numb arm which lasts for a few hours.
  • As for any procedure, we have to warn you that there are very small chances of rare complications such as infection.  
  • If we have used steroid and you have diabetes your blood sugar level can temporarily become less well controlled.Very occasionally you may feel some flushing sensations for the first day or two after the injection, as a normal side effect of the steroid.
  • Very rarely people can be allergic to the injection, which results in redness and itching. This is not serious, but we need to know for future treatments. 
  • Serious complications with this procedure are extremely rare, but if problems arise please consult the Pain Clinic Office, or your own doctor who will contact the Pain Clinic if necessary.

(Please see general comments on the Procedures page)

Links

The Trust's information sheet on stellate ganglion block can be downloaded here

  

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 22/6/2016