A specialized injection in the neck that targets the sympathetic nervous system to treat pain, circulation problems, and certain stress-related conditions in the head, neck, and upper extremity.
A Stellate Ganglion Block (SGB) is a procedure used to treat various types of chronic pain and certain autonomic dysfunctions by targeting the stellate ganglion, which is a collection of nerves located in the neck usually near the C6 and C7 vertebrae. By injecting a local anesthetic (sometimes with steroids) into or near this ganglion, the procedure helps block nerve signals, providing relief for specific conditions that involve sympathetic nerve dysfunction.
The stellate ganglion is part of the sympathetic nervous system, which controls involuntary body functions like heart rate, blood flow, sweating, and temperature regulation in the upper body. When the sympathetic nerves become overactive or dysfunctional, they can contribute to chronic pain, poor circulation, and other symptoms in the head, face, neck, arm, and hand.
A stellate ganglion block works by temporarily calming these overactive sympathetic nerves. The injection is placed near the front of the neck, alongside the voice box, where the stellate ganglion sits against the spine. When the block is successful, you may notice warmth in the hand on the treated side, a drooping eyelid, and a slightly stuffy nose. These are all expected signs that the sympathetic nerves have been effectively blocked.
This procedure has a long history in pain management and has also gained attention in recent years for its potential benefits in treating post-traumatic stress disorder (PTSD) and certain anxiety-related conditions, though these applications are still being studied.
Stellate ganglion blocks are used for a range of conditions involving the sympathetic nervous system in the upper body. You may be a candidate if you have:
Your doctor will evaluate your condition and symptoms to determine whether a stellate ganglion block is appropriate for your specific situation.
The procedure is performed in an outpatient setting and typically takes about 15 to 20 minutes.
You will lie on your back with your neck slightly extended. The front of your neck is cleaned and sterilized. Your doctor will identify the proper anatomical landmarks by feeling the structures of your neck.
Using ultrasound or fluoroscopic guidance, a thin needle is carefully directed to the area near the stellate ganglion at approximately the C6 level, alongside the trachea (windpipe) and adjacent to the spine. Imaging guidance is important because of the sensitive structures in this area, including blood vessels, the esophagus, and the airway.
Once the needle is properly positioned, a small amount of local anesthetic is injected. You may feel pressure in your neck during the injection. Within minutes, you may begin to notice signs that the block is working, including warmth and flushing in the hand on the treated side, a drooping eyelid (Horner's syndrome), nasal congestion, and possibly a feeling of a lump in the throat. All of these are temporary and expected.
You will be monitored for 20 to 30 minutes after the injection before being discharged.
Stellate ganglion blocks are covered by most insurance plans, including Medicare, when performed for documented sympathetically mediated pain conditions. Our office will confirm your coverage and discuss expected costs ahead of time.
Recovery from a stellate ganglion block is relatively quick, though the temporary side effects can feel unusual if you are not expecting them.
The Horner's syndrome symptoms (drooping eyelid, constricted pupil, nasal stuffiness on the treated side) typically last two to four hours and resolve completely on their own. You may also have a hoarse voice for a few hours due to the proximity of the injection to the vocal cord nerves. Avoid eating or drinking until any sensation of a lump in the throat has fully resolved.
Take it easy for the rest of the day. Mild soreness at the injection site is normal. Avoid strenuous activity for 24 hours.
The results of a stellate ganglion block vary depending on the condition being treated.
For CRPS, a single block may provide relief lasting hours to weeks. A series of blocks (typically three to six) is often performed, with many patients experiencing longer periods of relief with each successive treatment. The improved blood flow and reduced pain from the block can also make physical therapy more effective.
For vascular conditions, the temporary improvement in circulation can help with healing and symptom management.
If the block provides consistent but short-lived relief, your doctor may discuss longer-lasting interventions for the sympathetic nerves.
Here is what to keep in mind before your stellate ganglion block:
Medications: Inform your doctor about all medications, especially blood thinners. These typically need to be stopped before the procedure.
Eating and drinking: You may be asked to avoid food and drink for a few hours before the procedure because of the injection's location near the throat.
Side effects: Understand that Horner's syndrome (droopy eyelid, flushed face, stuffy nose) is an expected and temporary sign that the block worked. It is not a complication.
Voice changes: Temporary hoarseness is possible. Plan to avoid important phone calls or presentations for the rest of the day.
Transportation: You will need someone to drive you home.
Allergies: Report any allergies to local anesthetics, steroids, or contrast dye.
Complex regional pain syndrome in the arm or hand causes severe burning pain, swelling, and skin changes. A stellate ganglion block calms the overactive sympathetic nerves driving these symptoms.
Conditions like Raynaud's syndrome cause poor blood flow to the fingers, leading to pain and color changes. Blocking the stellate ganglion improves circulation and relieves symptoms.
A successful block causes Horner's syndrome on the treated side, which includes a drooping eyelid, a constricted pupil, and nasal stuffiness. These effects are temporary and resolve within a few hours. They are actually a reassuring sign that the block worked.
Like other sympathetic blocks, stellate ganglion blocks are often done in a series of three to six treatments. Each block can provide progressively longer periods of relief, and the improved blood flow supports physical therapy and functional recovery.
