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The stellate ganglion is a collection of nerves (sympathetic) found at the level of the sixth and seventh cervical vertebrae (the last vertebra of the neck). The nerves are located in front of the vertebrae.
They are part of the sympathetic nervous system and supply the face and arm. These nerves are not involves with feeling or movement. Sometimes, after a nerve is sensitized by trauma, infection or other causes, the sympathetic activity can cause pain.
Blocking the sympathetic activity by anesthetizing the stellate ganglion may stop the pain. A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck.
A stellate ganglion block is done to:
- Diagnose the cause of pain in the face and head, arms and chest
- Manage pain in the head, neck, chest or arm caused by nerve injuries, the effects of an attack of shingles (herpes zoster) or angina that doesn't go away
- Reduce sweating in the face, head, arms and hands
- Treat reflex sympathetic dystrophy, sympathetic maintained pain or complex regional pain syndrome
A stellate ganglion block can be either diagnostic -- done to find the cause of a patient's pain -- or therapeutic -- done to relieve the pain.
How a Stellate Ganglion Block is Done
During a stellate ganglion block, pain-relieving medicine is injected to the region where the ganglion lies. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain.
The patient is usually sedated, and using X-ray (fluoroscopy) guidance, a fine needle is placed near the stellate ganglion and anesthetic is injected.
The patient will not feel numbness in the face. They will have a droopy eye, redness of the eye, feel warmth in the face and may experience hoarseness of the voice. These effects are temporary and last a few hours. Pain relief may also not be immediate. A pain diary is used following the procedure to track the response.
The animation below shows how a stellate ganglion block procedure is done.