Stellate Ganglion Block

A stellate ganglion block (SGB) is a medical procedure in which a local anesthetic is injected into the stellate ganglion—a cluster of nerves located in the lower part of the front side of the neck. The stellate ganglion is part of the sympathetic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, sweating, and blood flow.

Purpose and Uses

SGBs are primarily used for pain management and circulatory issues, with emerging applications in mental health:

• Chronic pain conditions: Complex regional pain syndrome (CRPS), phantom limb pain, shingles-related neuralgia (herpes zoster), cluster headaches, and postherpetic neuralgia.
• Circulatory issues: Peripheral artery disease and sympathetically maintained pain.
• Mental health: Post-traumatic stress disorder (PTSD), anxiety, and depression, though these are considered off-label uses. Recent studies also explore SGBs for long COVID, menopause-related hot flashes, and traumatic brain injury (TBI).

How It Works

The outpatient procedure involves injecting a local anesthetic (sometimes with a steroid) near the stellate ganglion using imaging guidance (ultrasound or fluoroscopy) to ensure accuracy. By blocking the sympathetic nerves, the SGB interrupts pain signals and can also affect the body’s stress response, potentially providing relief from both physical and psychological symptoms. The process takes approximately 30 minutes, followed by 40-60 minutes of monitoring.

The block works by temporarily numbing the stellate ganglion, which:

• Reduces pain and other symptoms in the head, neck, upper chest, and arms on the same side as the injection
• May improve blood flow and reduce swelling, color changes, and abnormal sweating
• Can modulate the autonomic nervous system, potentially influencing the cardiovascular, endocrine, and immune systems through connections with the brain.

The most common side effects of Stellate Ganglion Blocks are generally mild, temporary, and occur on the side of the injection. They typically resolve within a few hours. The most frequently reported side effects include drooping eyelids, bloodshot eye, nasal congestion or stuffy nose, horse voice, sensation of a lump in the throat, difficulty swallowing, tearing or watery eyes, and bruising or soreness at the injection site.

These effects are due to the temporary interruption of sympathetic nerve activity and are expected after the procedure.

General Effectiveness

In summary, Stellate Ganglion Blocks offer a promising option for chronic pain and emerging mental health applications, though insurance coverage remains inconsistent for off-label uses. While effectiveness varies, combination therapies and ongoing research may expand its therapeutic potential.