Dr. Tory McJunkin, performs a stellate ganglion block to treat chronic pain. The stellate ganglion block is a short, minimally invasive procedure that can effectively treat a wide variety of conditions such as sympathetic-related pain in the face, chest, and upper extremities.
Watch Pain Doctor Tory McJunkin Perform a Stellate Ganglion Block Procedure Live.
When pain management with medications is unsuccessful, interventional nerve blocks can be used to treat certain types of acute and chronic pain. In nerve blocks, a combination anesthetic and steroid solution is injected into nervous tissue to reduce inflammation and block the transmission of pain signals to the brain1.
Some nerve blocks target a specific segment of the nervous system known as the sympathetic nervous system. The sympathetic nervous system isn’t under voluntary control and contains many neural pathways that communicate pain to the brain; it also controls many “fight or flight” responses from the brain, such as increases in heart rate and pupil dilation.
Stellate Ganglion Block Anatomy
The stellate ganglion refers to the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion as they meet anterior to the vertebral body of C7. It lies anterior to the prevertebral fasci and anterolateral to the longus colli muscle. Its alar fascial plane may communicate with the brachial plexus and the vertebral artery and it is in close proximity to the carotid sheath, phrenic nerve, and recurrent laryngeal nerve.
A stellate ganglion block (SGB) targets clusters of sympathetic nerves, or ganglia, that participate in the communication of pain signals from the head, neck and upper extremities1. The SGB is an important treatment for a condition known as complex regional pain syndrome (CRPS). CRPS affects the extremities with a variety of symptoms including pain, swelling, and skin and bone changes, and most commonly occurs after significantly stressful medical events such as a heart attack or stroke3. The SGB has been reported to provide effective pain relief for this condition, and may even help reverse the course of early disease. These nerve blocks have also been used to treat the painful symptoms of shingles and sympathetic dystrophy, as well as increase regional blood flow1, 2.
Stellate Ganglion Block Procedure
The spine is divided into four major regions; the cervical (neck), thoracic (upper back), lumbar (lower back) and sacral (hip/tailbone) regions. During a stellate ganglion block procedure, the side of the neck is numbed with a local anesthetic and a needle is inserted and guided just adjacent to the lowest cervical vertebrae (C7)1, 2.
The stellate ganglion block can be performed in many ways. One of the most common ways to perform the stellate ganglion block is to perform it at the C6 level. Relatively large volumes (5-20ml) are injected 2mm superficial to the C6 tubercle. This is done to spread the solution downward to reach the stellate and upper thoracic ganglia. The stellate ganglion block can also be approached from at C7 with administration of a smaller volume; however, this approach increases the risk of vertebral artery injection and collapsed lung (pneumothorax). Another possible approach to this block is the posterior paravertebral approach. With this method the needle is walked off the upper thoracic lamina until correct needle placement is confirmed with fluoroscopy and contrast dye. Some physicians may also use ultra-sound guidance to decrease the chance of injury to vascular and soft tissue structures that are adjacent to the stellate ganglion.(3,11,13) You will be asked to lie down on your back with your neck slightly extended, your head rotated slightly to the side opposite of the block, with your mouth open. Your neck will be prepped and draped in a sterile manner before local anesthesia is administered at the point of entry of the needle into the skin.
After your skin is anesthetized your physician will retract your sternocleidomastoid muscle and carotid artery as his or her index and middle fingers palpate your Chassignac’s tubercle. Your skin and subcutaneous tissue will be pressed firmly onto the tubercle to reduce the distance between the skin surface and bone. This is done to reduce the chance of pneumothorax (collapsed lung) occurring. This may be mildly comfortable. Upon palpating these anatomical landmarks the needle is then advanced under fluoroscopy guidance until correct needle placement is obtained. Correct placement is also confirmed by administration of contrast dye. Once position is confirmed local anesthetic is administered. A successful block is marked by profound pain relief and improved vascular flow to ipsilateral upper extremity. Local anesthetic is usually administered for diagnostic stellate ganglion block. For patients who have a documented response to administration of local anesthetic onto the stellate ganglion, a therapeutic block can be performed with administration of the neurolytic agent like phenol. Radioablation of the stellate ganglion is also another treatment modality for longer-lasting pain relief. Some patients may experience a constellation of symptoms known as Horner’s Syndrome (drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block was preformed). This is normal and symptoms usually subside when the anesthetic wears of (usually ~4-6 hours after the block is preformed). The procedure usually takes less than 15 minutes. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure, temperature) after the procedure and place you in a sitting position to facilitate the spread of the anesthetic.
To accomplish this, the patient lies on their back and slightly extends the neck allowing a doctor to