Stellate Ganglion Blocks

Sympathetic innervation to the face and upper extremity passes through the stellate ganglion. It is this anatomic feature which allows us to block the sympathetic nervous system to these regions for such conditions as reflex sympathetic dystrophy or post-herpetic neuralgia. The fibers originate off the T1 to T8 spinal cord segments, and ascend to synapse in the inferior (stellate), middle, or superior cervical ganglia. Again, however, the majority of the fibers pass through the stellate ganglion. The ganglion lies anterior to the C7 transverse process, but because of its close proximity to the lung at this level, the block is performed at the C6 level (Chassaignac's tubercle). Due to the close proximity of major vascular structures, the risk of intravascular injection poses a significant consideration. Intravascular injection of even a small amount of local anesthetic could potentially result in seizure activity. Therefore, intravenous access should be established prior to performing the block. The patient is placed in the supine position, the neck prepped with betadine, and a 25 gauge needle is placed down onto the tranverse process of C6. This is usually at a fairly shallow depth. A local anesthetic solution is then injected after negative aspiration for heme is performed. The patient is observed for a Horner's syndrome, and the skin temperature of the upper extremities monitored for the expected increase. Complications include intravascular injection, hoarseness, difficulty swallowing, weakness of the upper extremity, and intrathecal injection. Clearly, this block should only be performed in an area with full resuscitative equipment, and by personnel adept at handling these complications.

Learn about our other Sympathetic Blocks.