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Stellate ganglion block


Key Points

  • Used for treatment or diagnosis of complex regional pain syndromes as well as upper limb vascular syndromes.

  • Ultrasound appears to allow a more effective and precise sympathetic block.

  • Long-lasting local anesthetics with steroid are commonly used.

  • C7 transverse process and longus colli muscle must be located with a high-frequency linear transducer (6-13 MHz).

  • The needle should be directed in-plane from lateral to medial towards the prevertebral fascia located over the longus colli muscle and below the carotid artery.

  • A total of 5 mL of local anesthetic is then injected with real time visualization of spread, avoiding intravascular injection.

Perspective

This is also called a cervicothoracic sympathetic block and has been used since the 1920s for treatment or diagnosis of complex regional pain syndrome. It has also been used to treat refractory angina, phantom limb pain, vascular insufficiency, and other pain and vascular syndromes.

Stellate ganglion blocks have traditionally been performed blindly by palpating the anterior tubercle of the transverse process of C6 (Chassaignac tubercle) and infiltrating as much as 20 mL of local anesthetic. This method has a relatively high failure rate, with numerous significant and even potentially fatal adverse effects.

Ultrasound allows for a more effective and precise sympathetic block with the use of a small injectate volume. It may also improve the safety of the procedure by real-time visualization of vascular structures and soft tissue structures.

Indications.
Pain Syndromes Vascular Insufficiency
Complex regional pain syndrome type I and II Raynaud’s syndrome
Refractory angina Scleroderma
Phantom limb pain Frostbite
Herpes zoster Obliterative vascular disease

  • Vasospasm

  • Trauma

  • Emboli

Angina Hyperhidrosis

Pharmacologic Choice. Even during diagnostic use of stellate ganglion block, it is often desirable to produce a long-lasting block. Therefore a solution of 0.25% bupivacaine or 0.2% ropivacaine with epinephrine is often used. Steroid coadjutants are frequently added in this technique.

Thermal and pulsed radiofrequency have been successfully used in some cases and can be considered an option in the treatment of these patients to prolong the effects of the blockade.

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