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What is Stellate Ganglion Block?
Stellate
Ganglion Block is an injection of local anesthetic in the
sympathetic nerve tissue, the nerves that are located on the
either side of the voice box, in the neck.
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Effects of Stellate Ganglion Block
The injection blocks the sympathetic nerves, which may
reduce pain, swelling, color, and sweating changes in the
upper extremity and may also improve mobility.
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Candidates for Stellate Ganglion
Block
This procedure is done as a part of the treatment of Reflex
Sympathetic Dystrophy, Sympathetic Maintained Pain, Complex
Regional Pain Syndrome, and Herpes Zoster (shingles),
involving upper extremity or head and face.
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Your
Consultation
First, the doctor will evaluate the patient and explain the
procedure in detail, including possible complications and
side effects. The doctor will also answer any questions that
the patient may have and the patient should also inform the
doctor of his current medications so he could be advised to
continue taking the medications or not. The patient will
also be required to fast for 6 hours before the procedure.
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The Stellate Ganglion Block
Procedure
The
injection consists of a local anesthetic and epinephrine may
be added to prolong the effects of the injection. The actual
injection takes only a few minutes and it is done either
with the patient laying flat or slightly sitting up, with
the chin slightly raised. The patient will be monitored with
EKG, blood pressure cuff and blood oxygen-monitoring
devices. Temperature sensing probes will also be placed on
the thumbs or hands. The skin in the front of the neck, next
to the voice box will be cleansed with antiseptic solution
and then the injection is carried out.
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Recovery
You may
feel your upper extremity getting warm immediately after the
injection. You may also notice that your pain may be gone or
quite less. You may also become aware of "a lump in the
throat" as well as hoarse voice, droopy and red eye, and
some nasal congestion on the side of the injection. It is
possible that you may develop a headache.
It is
recommended that you should take it easy for a day or so
after the procedure. Some of the patients may go for
immediate physical therapy. You should be able to return to
your work the next day unless there are complications. The
most common thing you may feel is just some soreness in the
neck at the injection.
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Risks
The most common side effect is temporary pain. Other risks
involved are bleeding, infection, spinal block, epidural
block, and injection into blood vessels and surrounding
organs. Fortunately, serious side effects and complications
are uncommon in this procedure.
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Frequently Asked
Questions
Q:
What is the purpose of Stellate Ganglion Block?
A: This procedure is performed to determine if there is damage to the
sympathetic nerve chain and if it is the source of the
patient’s arm pain. This is mainly a diagnostic block but
may also provide pain relief in excess of the duration of
the anesthetic.
Q:
Will the injection hurt?
A:
The procedure involves inserting a needle through skin and
deeper tissues (like a "tetanus shot") so expect some
discomfort. But it is possible to numb the skin and deeper
tissues with a local anesthetic using a very thin needle
before inserting the actual block needle. Most of the
patients also receive IV sedation and analgesia, which makes
the procedure easier to tolerate.
Q: How
many injections do I need?
A:
You
will be recommended for repeat injections if you respond to
the first injection. A series of such injections is usually
required to treat the problem. Some may need only 2 to 4 and
others may need more that 10. The response to such
injections varies from patient to patient.
Q:
Will the Stellate Ganglion Injection help me?
A:
It is
very hard to tell if the injection(s) will indeed help you
or not. The patients who present early during their illness
tend to respond better compared to those who have this
treatment after about six months showing symptoms. But
patients in the advanced stages of disease may not respond
adequately.
Q: How
long will the effect of the medication last?
A:
Expect the local anesthetic to wear off in a few hours but the blockade
of sympathetic nerves may last for many more hours. The
duration of relief usually gets longer after each injection
Q: What
are the expected results of this procedure?
A:
The patient may notice an increased warmth and redness of
the painful arm during and after the injection. Also, expect
some hoarseness in the voice, redness of the eye, drooping
of the eyelid and pupillary constriction for 4 to 8 hours
after the injection. But pain relief may be noted
immediately. The duration of relief may vary. The patient
should assess the pain relief over the first 3 to 4 hours
after the injection and report this to the anesthesiologist.
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