Stellate Ganglion Block
Indication: CRPS of arm, neck and head, headache
The stellate ganglion is a sympathetic ganglion innervating the ipsilateral upper extremity, the neck and the head. The structure is usually located in front of the junction between C7 vertebral body and the transverse process. Stellate ganglion block is primarily indicated for complex regional pain syndrome of the head, neck and upper extremities. Uncontrolled clinical reports indicate this procedure provides effective pain relief or may even reverse the course of early stage complex regional pain syndrome type I. Other indications include vascular insufficiency of the arm and acute herpes zoster infection.
Technically, this block is achieved by inserting a needle through the neck to the front of the junction between the C7 vertebral body and the transverse process. Traditional hand palpation technique without guidance of fluoroscopy bears significant risks of injecting local anesthetics into critical structures in the neck, such as the carotid and vertebral arteries or intrathecal space. Incorrectly located injections of local anesthetics may lead to loss of consciousness, seizures, paralysis, cardiac arrest and death. Recent use of fluoroscopic guidance for stellate ganglion block dramatically decreases the possibility of serious side effects and increases the rate of success.