Stellate Ganglion Block (Sgp)

            Stellate ganglion block (cervicothoracic ganglion) is an injection of drugs into a nerve bundle of the upper body’s sympathetic nervous system (SNS). The stellate ganglion is located on both sides of the trachea at the level of C7 (7th cervical vertebra). The stellate ganglion has neurons that connect to central nervous system (CNS) nuclei that modulate body temperature, neuropathic pain, and other areas.

       Stellate ganglion block is primarily used to aid in the diagnosis and treatment of conditions involving upper extremity pain, circulatory problems, and sensory changes maintained by the sympathetic nervous system.

                Where is Stellate Ganglion Block Used?

1-Complex Regional Pain Syndromes (CRPS) Types 1 and 2 – Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is a condition involving chronic, intense pain that usually occurs in the arms, hands, legs or feet. In addition to allodynia, hyperalgesia, and central sensitivities, CRPS patients may experience changes in skin texture, colour, and temperature of the affected extremities, and decreased range of motion.

2-Shoulder-hand syndrome – Stellate ganglion block can be used to treat this chronic condition of the shoulder and arm, which includes persistent pain, limited joint movement, swelling of the upper extremities, muscle fibrosis and atrophy, and joint calcification.

3-Post Herpetic Neuralgia (PHN) – PHN is a painful complication of shingles (herpes zoster). Shingles are caused by the reactivation of the dormant chickenpox virus (varicella zoster) found in the nervous tissue. In PHN patients, stellate ganglion blocks reduced pain and oedema, as well as improved the mobility of the upper extremities.

4-Phantom pain (Ghost limb) – Phantom limb pain is the pain felt in the area where the limb was cut. Block of the stellate ganglion has been shown to provide significant relief of pain and sensation of warmth in the stump area and phantom upper extremity.

5-Persistent angina – Angina; is a type of chest pain caused by reduced blood flow to the heart muscle. Unfortunately, angina refractory to optimal drug therapy and revascularization is becoming an increasingly common clinical problem. Intractable angina occurs when angina pain is chronic, severe, and difficult to control, and may occur at rest or during simple activities of daily living. Stellate ganglion block can be applied in the treatment of upper body pain caused by angina.

6-Arterial insufficiency – This is the insufficiency of blood flow through the arteries. One of the most common causes of arterial insufficiency is atherosclerotic disease. Stellate ganglion block can help treat upper body pain caused by arterial insufficiency.

7-Raynaud’s phenomenon – A condition that causes the tips of certain body parts (eg fingers, toes, nose tip, ears) to feel cool and numb in response to cold and stress. During Raynaud’s disease, affected areas of skin often turn white, then blue. The skin becomes cold, lethargic, and sensory perception is dulled. These reactions occur due to vasospasm, a sudden narrowing of blood vessels that reduces blood flow to the involved areas. Stellate ganglion blockade helps reduce vascular spasms and pain.

8-Scleroderma – Scleroderma is an autoimmune disease of the connective tissue that involves the formation of scar tissue in the skin and organs. Scleroderma causes excessive fibrosis in body tissues. Stellate ganglion blocks have benefited patients with scleroderma.

9-Hyperhidrosis – Stellate ganglion blocks help you control hyperhidrosis (excessive sweating) of the face and upper extremities.

10-Hot flashes – Studies have shown that stellate ganglion blocks can help you control hot flashes caused by menopause and other causes, as well as related sleep dysfunction.

                   Stellate Ganglion Block Procedure

         A stellate ganglion block is a fast, minimally invasive procedure that can effectively treat a wide variety of conditions. In the procedure, which normally takes only 15 minutes, intravenous (IV) sedation is given to the patient to ensure patient comfort. It is monitored to monitor body functions (heart rate, blood pressure, temperature). The patient will first be placed in a supine position and the head will be slightly turned to the side. After the neck procedure site has been sterilized and covered, fluoroscopy is used to help visualize the injected site. Fluoroscopy is an X-ray imaging technique that provides real-time, live images of the patient’s internal structures using an X-ray source and fluorescent screen. After the stellate ganglion location is confirmed by fluoroscopy, a drug consisting of a mixture of local anaesthetic (lidocaine, bupivacaine) and corticosteroid is injected into the area containing the target sympathetic nerve ganglion.

     The operator will then evaluate the effects of the nerve block on the patient’s pain. If the nerve block relieves the patient’s pain, he will then create a treatment plan that includes neurolytic agents or radiofrequency ablation procedures.

     The major benefit of sympathetic nerve blockade is the rapid relief of symptoms, which is provided to many patients with chronic SNS-related pain. Other important benefits include improved circulation and modulation of temperature fluctuations in patients with SNS-related conditions. Most patients who respond to nerve blocks regain the ability to continue their normal daily activities and report a higher quality of life.

       Stellate ganglion blockade has been demonstrated as a low-risk procedure. This is because stellate ganglion blockade is a minimally invasive treatment. Less invasive treatments carry lower complication rates than more aggressive, riskier treatments such as open surgery, which carries a higher risk of infection and other serious complications.

        As with any medical procedure, stellate ganglion block is also associated with risks. However, the minimally invasive nature of this treatment makes the procedure a safe and reasonable approach. Reported complications of stellate ganglion nerve block include infection, bleeding, pneumothorax, nerve damage, and drug-related pharmacological complications. Some patients may experience short-term pain at the injection site. In addition, blockade of the sympathetic nerves can cause a temporary set of symptoms called Horner’s Syndrome, which occasionally includes drooping eyelids and nasal congestion; however, these effects usually resolve within hours.