Cervicothoracic or Stellate Ganglion Block
The cervicothoracic or stellate ganglion belongs to the orthosympathetic
system. It extends from the transverse process of C7 to the neck of the first rib,
between the longus colli muscle posteriorly and the carotid and
Figure 45-25
Laryngeal nerve block.
vertebral arteries anteriorly. It is in close contact with the subclavian artery,
the recurrent laryngeal nerve, the inferior thyroid artery, and the apical pleura
(right side mainly). Performance of a block of the cervicothoracic ganglion should
be considered hazardous. The technique has two main pediatric indications: severe
circulatory disturbances of one of the upper limbs (because it produces considerable
vasodilatation) and severe ventricular tachyarrhythmias due to familial syndromes
with prolonged QT intervals on electrocardiographic tracings.[288]
Treatment of pediatric herpes zoster ophthalmicus may also benefit from this technique.
[289]
The patient is in the dorsal recumbent position, with the hands
extended along the chest. A pillow is slipped under the neck to extend the esophagus
while the head is maintained in a strictly median plane. The puncture is made at
the skin projection of the transverse process of C6 just posterior to the medial
border of the sternocleidomastoid muscle. With his or her fingers, the anesthesiologist
moves the carotid artery and trachea laterally before inserting the needle vertically
until it contacts the transverse process. The needle is then slightly withdrawn
(1 to 2 mm) before 0.3 mL/kg (up to a maximum of 15 mL) of lidocaine, bupivacaine,
or ropivacaine is injected. The solution can spread a considerable distance along
the sympathetic chain.[290]
The sympathetic block
produced covers the thorax, the axillary region, and the upper limb. Successful
blockade results in Horner's syndrome.
