Stellate Ganglion Block

Stellate Ganglion Block (SGB) is a specialized interventional procedure that targets the sympathetic nervous system to help manage complex pain conditions, especially Complex Regional Pain Syndrome (CRPS) and certain nerve-related disorders.

The stellate ganglion is a collection of nerve cells in the neck that is part of the sympathetic nervous system – the system that controls fight-or-flight responses. When this system becomes overactive after injury or surgery, it can cause severe, burning pain and other symptoms.

At Palm Beach Regenerative, Dr. Ghattas performs this advanced procedure with precision image guidance for optimal safety and accuracy.

The Sympathetic Nervous System:

The sympathetic nervous system normally helps regulate blood flow, temperature, and other automatic body functions. After certain injuries or surgeries, this system can malfunction, causing:

• Severe burning pain out of proportion to injury
• Skin temperature and color changes
• Excessive sweating
• Hypersensitivity to touch
• Limited range of motion

The Procedure:

SGB involves precise injection of anesthetic medication near the stellate ganglion (located in the neck) to temporarily block abnormal sympathetic nerve activity. This may:

• Interrupt pain signals
• Help reset sympathetic tone
• Improve blood flow to affected limb
• Reduce inflammation
• Break pain cycle

Image Guidance:

Due to the stellate ganglion’s location near critical structures (arteries, veins, nerves, lung apex), Dr. Ghattas uses real-time fluoroscopic (X-ray) guidance or ultrasound visualization with contrast dye to confirm accurate placement.

Complex Regional Pain Syndrome (CRPS):

• Type I (no confirmed nerve injury)
• Type II (confirmed nerve lesion)
• Upper extremity CRPS
• Refractory to other treatments

Nerve Pain Conditions:

• Neuropathic pain in arm or hand
• Post-herpetic neuralgia (shingles pain) in upper body
• Phantom limb pain
• Post-traumatic neuralgia

Vascular Conditions:

• Raynaud’s phenomenon affecting hands
• Certain upper extremity vascular insufficiency conditions

Other Applications:

• Severe upper extremity pain not responding to other treatments
• Hyperhidrosis (excessive sweating) of hands

Targets Root Cause:
Unlike treatments that mask pain, SGB may address underlying sympathetic dysfunction contributing to pain.

Diagnostic and Therapeutic:
Response to SGB helps confirm sympathetically-mediated pain and predicts response to further treatment.

Series Approach:
Often requires series of blocks (typically 2-10) for optimal and lasting results.

Specialized Expertise:
Requires advanced training and image guidance for safe, effective performance. Dr. Ghattas’s fellowship training in interventional pain management includes extensive SGB experience.

Pre-Procedure:

• Detailed history and physical examination
• Review of imaging and diagnostic studies
• Discussion of risks, benefits, and expectations
• Consent process
• IV access may be placed for safety

Procedure (20-40 minutes):

• Patient positioned on fluoroscopy or ultrasound table
• Monitoring equipment applied (blood pressure, pulse, oxygen)
• Neck area cleaned and sterile field created
• Image guidance used to identify stellate ganglion location
• Local anesthetic applied to skin
• Precise needle advancement under continuous imaging
• Contrast dye confirms proper position
• Anesthetic medication injected (typically 5-10cc)
• Immediate assessment for successful block

• Horner’s syndrome (droopy eyelid, small pupil, nasal congestion on treated side) – temporary and expected
• Warming and color change in affected arm/hand
• Voice changes (temporary hoarseness) – common and resolves
• Reduction in pain (may be immediate or develop over hours/days)

Total Time: Approximately 1-1.5 hours including preparation and recovery

Immediate (0-2 hours):

• Remain in office for observation
• May experience temporary Horner’s syndrome symptoms
• Temporary arm weakness or numbness possible
• Voice changes typically resolve within hours
• Most patients drive home without difficulty

Early Response (Day 1-7):

• Temporary symptoms from block resolve (usually 4-8 hours)
• May notice immediate pain relief that lasts days to weeks
• Some patients experience delayed response (improvement over days)

Series Protocol:

For CRPS and other chronic conditions:

• Typically need series of 2-10 blocks
• Spaced 1-4 weeks apart
• Progressive improvement with each block in responsive cases
• May combine with physical therapy and other treatments

Long-Term:

• Some patients achieve sustained relief after series
• Others need periodic maintenance blocks
• Often combined with comprehensive pain management approach

For CRPS patients, many report:

• Significant reduction in pain intensity
• Improved function and use of affected limb
• Enhanced response to physical therapy
• Reduced need for pain medications
• Improved quality of life

Important Factors:

• Early treatment generally better outcomes
• Series of blocks typically needed
• Response to first block predicts overall success
• Comprehensive approach (therapy, psychology, medications) enhances outcomes

May be appropriate when:

• You have confirmed or suspected CRPS
• You have sympathetically-mediated pain
• Other treatments haven’t provided adequate relief
• You want to improve response to physical therapy
• Diagnostic procedure to identify pain mechanism

May be part of comprehensive plan including:

• Specialized physical therapy (desensitization, mirror therapy)
• Medications (neuropathic pain medications, etc.)
• Psychological support for chronic pain management
• Other interventional procedures
• Interventional orthobiologics for underlying injury

May NOT be best choice when:

• Pain is not sympathetically-mediated
• Contraindications to neck injections exist
• Active infection in injection area

• Fellowship-trained in interventional pain management
• Fluoroscopic or ultrasound guidance for safety
• Extensive experience with CRPS and complex pain
• Part of comprehensive pain management approach
• Systematic outcome tracking
• Can be combined with other treatments

Many insurance plans cover SGB for approved indications like CRPS. We provide:

• Pre-authorization assistance
• Insurance verification
• Transparent cost estimates
• Superbills for submission
• CareCredit financing if needed