Stellate Ganglion Injection Information

What is the Stellate Ganglion Chain?
The Stellate Ganglion chain carries many pain fibers from the upper extremity.  It is involved in some pain conditions such as Complex Regional Pain Syndrome (formerly known as Reflex Sympathetic Dystrophy).  The Stellate Ganglion chain runs in close relation to the lower cervical vertebrae.  This can be targeted for injection at a number of different levels; the procedure is most often performed at the C6 or C7 vertebrae.  Your doctor will tell you if there is a significant sympathetic component to your pain and you are a candidate for an injection of the Stellate Ganglion.  

How is a Stellate Ganglion Injection performed?
It is a relatively simple procedure in which the physician uses fluoroscopic guidance to place a small needle along the Stellate Ganglion chain.  You will need to lie still on your back for a few minutes so the procedure can be performed.  After you are brought into the room, your skin will be cleaned thoroughly.  Next, the physician will numb a small area of skin that may sting for a few seconds. The physician may use x-ray guidance to direct a small needle into the ideal position along the Stellate Ganglion.  After the needle is in the proper location, a small amount of contrast dye is injected to ensure the injection will flow as desired along the Stellate Ganglion.  The procedure will take a few minutes.  You may feel temporary discomfort as the needle passes through muscle.  Relief from the injection may wane after several hours to a few days and repeat injections are often necessary.

 
Here, after numbing the skin, the needle is placed in the neck.  

 
The needle and contrast can be seen on the fluoroscopy unit.

What should I do after the procedure?
No driving for eight hours. Do not apply heat to your neck for the first 24 hours after the procedure.  The injections should be done in conjunction with a physical therapy program.  Appointments for physical therapy should be made on the days of the procedure or the day following the procedure.  Speak to your physician if you have questions about the timing of therapy appointments in relation to the injections.  It is common after the procedure to have some droopiness of the eyelid, redness of the eye, a warm sensation of the upper extremity, and a small pupil.

General Pre/Post Instructions
You may eat a light, but not a full meal at least 3 hours before the procedure. If you are an insulin dependent diabetic do not alter your normal food intake. Take your routine medications before the procedure (such as high blood pressure and diabetes medications).  It is essential that you stop Aspirin for 7 days prior to the procedure and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro) 3 days before the procedure. These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are on coumadin, heparin, lovenex, plavix or ticlid you must notify the office so that the timing of stopping these medications can be explained. If you are on antibiotics please notify our office, we may wait to do the procedure. If you have an active infection or fever we will not do the procedure. You will need to bring a driver with you.