3.19 Stellate Ganglion

Question 1

Indications for stellate ganglion blockade

Answer 1

Sympathetic mediated pain

Vascular insufficiency

Question 2

Sympathetic mediated pain

Answer 2

1. CRPS 1+2
2. Refractory angina
3. Phantom Limb pain
4. Herpes Zoster
5. Shoulder / Hand syndrome
6. Angina

Question 3

Vascular insufficiency

Answer 3

1. Raynaud’s Syndrome
2. Scleroderma
3. Frostbite
4. Obliterative vascular disease
5. Trauma
6. Emboli

Question 4

Blockade technique Stellate Ganglion

Answer 4

Standard preop assessment + Consent

SLIMRAG

1. Anterior approach
   Supine with head extended
   some advocate turn to contra side + open mouth
2. Level C6
   cricoid cartilage
   displace sheath laterally
   whilst trachea moves medially

Question 5

Blockade technique Stellate Ganglion

Answer 5

3. Insert a 25mm 25 g needle
   directly perpendicular to skin
   onto TV process C6 (chassiagnacs tubercle)

4 Withdraw approx. 5mm
inject approx. 20mL LA

5. Large volume required for
   cephalic + caudal migration
   block lower thoracic segment ganglion
6. Fluoroscopic confirmation needle position
   before injection of LA

Question 6

Complications

Misplaced needle

Answer 6

Misplaced Needle

1. Haematoma from vascular trauma
   (Carotid, IJV, Vertebral)
2. Airway compression if large haematoma
3. Nerve trunk injury
   Vagus + RLNI
4. BP root injury
5. PTX
6. HTX
7. Chylothorax
8. Oesophageal perf

Question 7

Complications

Spread LA

Answer 7

Spread LA

IV injection -
carotid artery / vertebral A / IJV

2. Neuraxial / bp spread
   epidural / intrathecal block
3. Local spread
   -hoarseness
   (RLN)
   - Elevated hemidiaphragm
   (phrenic N.)
4. Horner’s Syndrome
   Ptosis
   Meiosis
   Enophthalmos

Question 8

Complications

Infection

Answer 8

Soft Tissue - abscess

Neuraxial - meningitis

Osteitis