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Ultrasound-Guided Stellate Ganglion Block: Safety and Efficacy

  • Anesthetic Techniques in Pain Management (D Wang, Section Editor)
  • Published:
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Abstract

Cervical sympathetic and stellate ganglion blocks (SGB) provide a valuable diagnostic and therapeutic benefit to sympathetically maintained pain syndromes in the head, neck, and upper extremity. With the ongoing efforts to improve the safety of the procedure, the techniques for SGB have evolved over time, from the use of the standard blind technique, to fluoroscopy, and recently to the ultrasound (US)-guided approach. Over the past few years, there has been a growing interest in the ultrasound-guided technique and the many advantages that it might offer. Fluoroscopy is a reliable method for identifying bony surfaces, which facilitates identifying the C6 and C7 transverse processes. However, this is only a surrogate marker for the cervical sympathetic trunk. The ideal placement of the needle tip should be anterolateral to the longus colli muscle, deep to the prevertebral fascia (to avoid spread along the carotid sheath) but superficial to the fascia investing the longus colli muscle (to avoid injecting into the muscle substance). Identifying the correct fascial plane can be achieved with ultrasound guidance, thus facilitating the caudal spread of the injectate to reach the stellate ganglion at C7-T1 level, even if the needle is placed at C6 level. This allows for a more effective and precise sympathetic block with the use of a small injectate volume. Ultrasound-guided SGB may also improve the safety of the procedure by direct visualization of vascular structures (inferior thyroidal, cervical, vertebral, and carotid arteries) and soft tissue structures (thyroid, esophagus, and nerve roots). Accordingly, the risk of vascular and soft tissue injury may be minimized.

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Dr. Samer Narouze declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA

    Samer Narouze

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  1. Samer Narouze
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Correspondence to Samer Narouze.

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This article is part of the Topical Collection on Anesthetic Techniques in Pain Management

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Narouze, S. Ultrasound-Guided Stellate Ganglion Block: Safety and Efficacy. Curr Pain Headache Rep 18, 424 (2014). https://doi.org/10.1007/s11916-014-0424-5

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  • DOI: https://doi.org/10.1007/s11916-014-0424-5

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