Stellate Ganglion Block
Clinical Applications
Blockade of the stellate ganglion is used primarily in the treatment
of upper extremity sympathetic dystrophy and for increase of blood flow to this area
(see Chapter 73
).
Technique
The patient lies supine, with the neck slightly extended. The
most prominent cervical transverse process—the Chassaignac tubercle (C6)—is
palpated between the sternocleidomastoid muscle and the trachea. The C6 tubercle
is palpated between the index and middle fingers, pushing the carotid artery laterally.
A skin wheal is raised between the fingers, over the tubercle, and a 22-gauge, 4-cm,
short-bevel needle with a 12-mL syringe attached is inserted in a perpendicular direction
until the tip contacts the C6 transverse process ( Fig.
44-26
). The needle is then withdrawn
Figure 44-26
A, Anatomic landmarks
and method of needle placement for a stellate ganglion block. B,
Cross-sectional view of a stellate ganglion block.
3 mm and is fixed. After careful aspiration, 8 to 12 mL of local anesthetic solution
is injected. Signs of a successful stellate ganglion block include Horner's syndrome,
anhidrosis, injection of the conjunctiva, nasal stuffiness, vasodilation, and increased
skin temperature.
Side Effects and Complications
Because of the proximity of several major neural and vascular
structures to the site of needle insertion, side effects and complications can occur.
They include block of the brachial plexus and recurrent laryngeal nerves, hematoma
formation, intravascular injection resulting in convulsions, and epidural and subarachnoid
injections.[61]
