Stellate Ganglion Block

The nerves going to the arm can be numbed in one of two places. One is the low neck, called a stellate block. The other is the upper chest, called a T2 sympathetic block. The Stellate Ganglion Block is done the same day you go home. It is usually done in the Operating Room or a Procedure Room. For your safety and comfort, you will be hooked up to monitors (EKG monitor, blood pressure cuff, and a blood-oxygen monitor). No IV or sedation is used; you stay awake under local anesthetic. Skin temperature monitors will also go on your hands. You lie on your back for the procedure.

A rolled-up sheet or other support goes between your shoulder blades. It may be a little uncomfortable. The doctor cleans your neck with a germ-killing wash. Then the doctor injects numbing medicine into the skin and tissue. This may burn for a few seconds. The doctor will also press on your neck to find exactly where to place the needle. It is very important that you do not talk, swallow, or cough. If you have to swallow or cough, raise your hand to let someone know.

Once the numbing medicine works, the doctor puts in another needle. Using a special X-ray machine called a fluoroscope, the doctor injects a dye that shows on X-ray (contrast solution). The dye confirms the needle is in the right spot. Then the doctor injects a small mix of numbing medicine (anesthetic) and anti-inflammatory medicine (cortisone/steroid).

The medicine takes about 10 to 20 minutes to work. You will stay at the Clinic until the doctor feels you are ready to leave. If the block works, your hand will warm up. Depending on the source of your pain, your pain may get better. For CRPS (RSD), stellate blocks are a way to get you working with physical or occupational therapy. The therapy makes your arm or hand less sensitive.

You will get medicine, so do not eat for four or five hours before the procedure. If you are a diabetic, talk with the doctor about when to eat and take your medicines. You may need to stop some medicines several days before the procedure. Tell the doctor about every prescription and over-the-counter medicine you take, including herbs and vitamins. The doctor will tell you if and when to stop them.

It is very important to tell the doctor if you have asthma. Also tell the doctor if you ever had an allergic reaction (i.e. hives, itching, trouble breathing, any care that put you in the hospital) to the dye from an earlier scan (CT scan, angiogram, etc). The same goes for any allergic reaction to shellfish (shrimp, scallops, lobster, crab). The doctor may give you some medicine to take before the procedure.

Tell the doctor if you get a cold, fever, or flu symptoms before your visit. You need to know about several possible side effects.

These side effects usually go away four to eight hours after the block. They may include:

• A droopy eyelid on the side of the block; Redness and blurred vision in the eye on the side of the block; A feeling like a lump in your throat; Difficulty swallowing; Hoarseness of your voice; Warmth and weakness of the arm on the side of the block.
• Drink plenty of clear liquids after the procedure to help flush the dye from the kidneys. Do not eat solid food until you can swallow comfortably.
• Most patients drive themselves home. If your arm feels weak or numb, have someone else drive until that wears off.
• Depending on how you feel, you may go back to normal activities and work the next day.
  If the doctor orders physical therapy, it is very important that you keep it up.
• You may feel much better right after the shot (from the numbing medicine). But your pain may come back within a few hours. The steroid may take a few days to start working.
• You must take part in physical therapy to get long-term control of symptoms. Desensitization physical therapy (therapy that trains the area to be less sensitive) can work well to treat oversensitivity. It works best when paired with other medical and/or therapy treatments. The stellate blockade is both diagnostic (helps find the cause of your pain) and therapeutic (treats the cause of your pain). You may need a series of shots to get long-term pain control. Keep track of your symptoms after the block.

• Collapsed lung
• Numbness of an arm that may last for hours
• Temporary weakness or numbness from the neck down
• Allergic reaction to the medication
• Nerve damage
• Bruising at the injection site
• Infection at the injection site
• Injection of medication into a blood vessel with possibility of stroke or seizure
• Post-injection flare (nerve root irritation with pain several hours after treatment, which may last days or weeks)
• Depigmentation (a whitening of the skin)
• Local fat atrophy (thinning of the skin)
• Destruction of a motor or sensory nerve in the path of the needle
• Bleeding, nerve injury, organ injury and death are rare but possible

Note: If you have new shortness of breath 24 – 48 hours after the shot, or any signs of infection where the shot went in, go to your nearest emergency room right away.

The first effect of a stellate ganglion block is simple, and you can often watch it happen. Sympathetic signals to the head, neck and arm are cut off. The eyelid on that side drops, the pupil narrows, and the face flushes and warms. Those signs confirm the block has worked.

What interests us is why the benefit sometimes outlasts a numbing drug that wears off within hours. Here is our working reason. Turning down the sympathetic system (the fight-or-flight side) tips the balance toward the vagus nerve (the rest-and-digest side). The vagus nerve is one of the main lines between the nervous system and the gut. Changes on that line affect how the gut moves, how well its lining holds, and the mix of bugs in the gut microbiome. Those, in turn, shape body-wide inflammation. They also shape the brain signals that keep both chronic pain and the on-edge alertness seen after trauma going.

Seen that way, a stellate ganglion block is not just switching off a sympathetic signal for an afternoon. It opens a window. In that window, a nerve-gut system that has been out of balance for a long time can start to reset. That is why we usually use a series of blocks, not a single one. It is also why we pair them with metabolic and lifestyle work and do not treat the shot as a one-time event.

We present this as our clinical reasoning, not as settled evidence, and we think the difference matters. The quick sympathetic effect is well proven. The nerve-to-microbiome link is still being actively studied. We would rather tell you which is which than blur the two together.