64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic)

Name of the Procedure:

Injection, anesthetic agent; stellate ganglion (cervical sympathetic)

Summary

The stellate ganglion block is a procedure where an anesthetic agent is injected into a collection of nerves in the neck to relieve pain. This collection of nerves is part of the cervical sympathetic chain and influences nerve sensations in the head, neck, chest, and arm.

Purpose

The stellate ganglion block is used to manage pain originating from the sympathetic nervous system. It aims to reduce pain, improve blood flow, and decrease symptoms of complex regional pain syndrome (CRPS), chronic pain conditions, or circulatory issues affecting the upper extremities.

Indications

• Complex Regional Pain Syndrome (CRPS)
• Chronic pain in the head, neck, arm, or chest
• Sympathetically-maintained pain
• Vascular insufficiency in the upper extremities
• Herpes zoster (shingles) involving the upper extremity

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies, like X-rays or MRIs, may be required to evaluate the target area.
• Adjustments to current medications, especially blood thinners, as advised by the physician.
• No alcohol consumption 24 hours before and after the procedure.

Procedure Description

1. The patient lies on an X-ray table with their head slightly turned to one side.
2. The neck area is cleansed with an antiseptic solution.
3. Using fluoroscopy (live X-ray) or ultrasound guidance, the physician identifies the exact location of the stellate ganglion.
4. A local anesthetic may be administered to numb the area.
5. A fine needle is inserted near the stellate ganglion.
6. The anesthetic agent is carefully injected.
7. The needle is removed, and the injection site is cleaned and bandaged.

Duration

The procedure typically takes about 30 minutes to complete.

Setting

The procedure is typically performed in an outpatient clinic, pain management center, or hospital radiology suite.

Personnel

• Pain management specialist or anesthesiologist
• Radiology technician (if fluoroscopy is used)
• Nurse or medical assistant

Risks and Complications

• Temporary or mild hoarseness
• Difficulty swallowing
• Infection at the injection site
• Bleeding or bruising
• Pneumothorax (collapsed lung, though rare)
• Nerve damage (very rare)

Benefits

• Significant reduction in pain levels
• Improved blood flow and circulation
• Relief from symptoms within minutes to hours
• Possible reduction in the need for oral pain medications

Recovery

• Patients are usually observed for 30-60 minutes post-procedure.
• Mild side effects like bruising or soreness at the injection site.
• Avoid strenuous activities for 24-48 hours.
• Follow-up appointments to monitor response and any need for additional injections.

Alternatives

• Oral or topical pain medications
• Physical therapy
• Sympathetic nerve blocks at other sites
• Surgery, in more severe cases
• Pros: Non-invasive or less invasive options may be sufficient for some patients.
• Cons: May not provide as targeted or effective pain relief as the stellate ganglion block.

Patient Experience

During the procedure, patients may feel a slight pinch from the needle or pressure in the neck area. Post-procedure, some discomfort at the injection site is normal. Appropriate pain management and follow-up care help ensure patient comfort and monitor effectiveness.