Stellate Ganglion Blocks

What is a stellate ganglion block?

A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck that 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. Stellate ganglion blocks are also used to see if blood flow can be improved in circulation problems typically from Raynaud’s or CREST.

Stellate ganglion blocks may be therapeutic and/or diagnostic. One of three things may happen. 1. The pain does not go away and there is other evidence of a sympathetic block – the pain is not responsive to sympathetic blocks -this is of diagnostic value. 2. The pain does not go away and there is not good evidence of a sympathetic block – 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 – the block was of therapeutic value. The procedure will most likely have to be repeated to get long lasting benefit. The spacing of injections will be based on how long the pain relief is between injections (usually you will get longer benefit after each injection).

Note: The procedure can not be performed if you have an active infection, flu, cold, uncontrolled cough, fever, very high blood pressure or if you are on blood thinners. Please make Dr. Dominguez aware of any of these conditions. This is for your safety!

What are the risks of the procedure?

The risks of the procedure, though infrequent, 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 medication, 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 (about 4 – 6 hours). They include drooping of the eyelid on the injected side, “bloodshot eye” on the injected side, stuffy nose on the injected side and a temperature increase on the injected side. You may also get hoarseness.

Will the injection hurt a lot?

Dr. Dominguez has to press on your neck to locate the area to be injected. The injection itself is done using a very small needle. The local anesthetic stings/burns going in.

How do I prepare for my procedure?

No solid food or fluids after midnight prior to the procedure unless directed otherwise. On the morning of the procedure, you may take your non paid medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before coming in. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication. Please make Dr. Dominguez aware that you are taking a blood thinner, and contact your primary care physician or prescribing physician before stopping this medication.

What happens during the actual procedure?

After signing a consent form and checking your blood pressure by the nurse, an intravenous 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 sheet rolled up between your shoulder blades. Your neck will be cleansed with an antiseptic soap. Dr. Dominguez 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 put in through the needle. The needle is removed and the procedure is complete. This usually takes about 5 – 10 minutes. 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 down. The medicine can take 10 – 20 minutes to take full effect. You will be watched during that time. Dr. Dominguez will be checking to see if the expected changes take place as well as see what effect if any there is on your pain. Your pulse and blood pressure will be checked. If all is well, your intravenous will be removed. Dr. Dominguez will authorize your discharge when you’re ready and your ride is present.

How will I feel after the injection?

Your neck may be tender or bruised feeling after the injection. One eye will be droopy. This may affect your sense of balance. You may get hoarseness. If you do you must be careful swallowing.

If your arm gets numb or heavy you will have to protect it (sling) until sensation returns – usually 4 – 6 hours. You may take your usual pain medications after the injection.
It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.

Will I have any restrictions on the day of the procedure?

You may not drive for the remainder of the day after the procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. The procedure will be cancelled if you don’t have a responsible adult with you!! This is for your safety.

Be careful swallowing after the injection (sips of water first) especially if you get hoarseness.

For what reasons should I call American Pain Institute after the injection?

If you experience new shortness of breath 24 – 48 hours after the injection or any signs of infection in the area of the injection, you should call us right away.