• Reference Number: HEY-537/2023
• Departments: Pain Medicine
• Last Updated: 29 September 2023

Introduction

This leaflet has been produced to give you general information about a treatment option known as stellate ganglion block.  Most of your questions should be answered by this leaflet.  This leaflet is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading the leaflet you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a stellate ganglion block?

A stellate ganglion block involves an injection of local anaesthetic into the collection of nerves in the lower end of the neck.

A stellate ganglion block may be used as part of a treatment plan to relieve pain coming from the head, neck or arm. It may also be used to increase the amount of blood that flows to areas in the upper part of the body.

Examples of conditions which the doctor may want to treat with a stellate ganglion block include complex regional pain syndrome of the upper limb, Reynaud’s syndrome and/or chest pain not due to heart disease.

Why do I need a stellate ganglion block?

You may have been experiencing pain at the neck and arms and following discussion with your doctor he suggests you have this treatment for pain relief.

Can there be any complications or risks?

There may be a little bruising at the site of needle insertion. You may experience a dry mouth, a hoarse or weak sounding voice, runny nose, and a slight droop in your eyelid.  You may experience a feeling of being a little out of breath and a warm feeling on your face. You may notice the pupil of one of your eyes is smaller than the other.

These are all the result of local anaesthetic spreading to the nerves. These effects are temporary lasting four to six hours at most. As with any injection, there is a very slight chance of getting an infection where the needle is placed.  Every effort is made to avoid this with the use of skin cleansing solution, sterile gloves and equipment.

The steroid drug used in the injection can occasionally cause such problems as diarrhoea and abdominal pain; this will resolve after a short period of time however if it continues consult your doctor. The steroid can also cause flushing and redness to the face which also will pass after a short period of time.

There is a chance one of the blood vessels in the neck could be punctured during the injection leading to bleeding and bruising.

There is also a small risk your lung could be punctured, this is extremely rare.  Despite the potential risks, the procedure is made as safe as possible by being performed by an experienced pain doctor who constantly monitors you throughout the procedure.

Advice to be read before having a pain relief procedure

The following information has been produced to ensure that you are able to have your pain relief procedure. It is essential that you read and follow the advice given below before you come to the hospital. If you do not follow the advice you may not be able to have your treatment.

Please contact the Pain Clinic if any of the following apply to you:

• You have recently had an admission to hospital.
• You have tested positive for Meticillin-resistant Staphylococcus aureus (MRSA).
• You have an infection and are currently taking antibiotics.
• You think you may be pregnant.
• You are diabetic and take medication to control your diabetes (see below on how to manage treatment sessions booked for the morning or the afternoon)

Continue your other regular medications including your pain relief. However, if you take any of the anticoagulants listed below, please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this.

If you take Warfarin (Marevan), Clopidogrel (Plavix), Dipyridamole (Persantin Retard), Phenindione, Pradaxa, Xarelto, Apixaban, Sinthrome or Asasantin Retard,  please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this. If you are on new oral anticoagulant medications like dabigatran then you will be required to stop it at least 48 hrs in before the procedure. This does not cover all blood thinning medications, please notify the Pain Clinic if you are taking any medications which thin your blood or prevent blood clots. Depending on the reason that you need to take these drugs you may need a short course of blood thinning injections.

You may have to wait a while before your procedure, so please bring something to read or do to keep yourself occupied.

Please leave any valuables or jewellery at home. It is essential that you have arranged for someone to drive you home after the procedure.  You will not be able to use the bus or train to travel home.

Please ensure that you have arranged for someone to drive you home after this procedure. Failure to do so will result in your procedure being cancelled.

If you have had sedation, we recommend that you arrange for someone to stay with you overnight and that you do not drive for 24 hours.

Hospital transport may be available if there is a medical need.  If you think you may be eligible please contact your doctor’s surgery.

Sometimes injections are done under sedation (a drug is given to make you drowsy and relaxed but still conscious).You should not have anything to eat on the morning of your treatment, however you may have a drink of water, tea or coffee (without milk) if you wish up to two hours before your appointment time.

Advice for diabetic patients only

If you are diabetic and are booked to attend treatment in the morning, you should not have breakfast nor take your morning diabetes medication but bring the drugs for your diabetes with you.

If you are booked for treatment in the afternoon please have your breakfast and take regular medications before 7.00 am. Thereafter only drink water, tea or coffee (without milk) for up to two hours before the procedure. Please inform the clinic staff as soon as you arrive that you are diabetic, the staff will then assess your diabetes and if necessary take appropriate action to monitor and control your blood sugar while you are in our care. 

What happens before the procedure?

You will be admitted by the nursing staff, one of whom will ask for and record some information about you.  Your blood pressure will be checked and you will be given a gown to put on.  The doctor will explain the procedure and ask you to sign a consent form.   Please make sure you have understood what has been said and feel free to ask any questions.

What to expect during the procedure 

As a precautionary measure, a thin plastic tube (cannula) may be inserted into a vein in your arm or hand.  Although rare, there is a chance there could be a drop in blood pressure or a seizure event following inadvertent injection of the local anaesthetic into the neck vessels.  The insertion of the cannula also assists sedation if required.  You will be made comfortable resting back on a trolley. After cleaning the base of your neck with antiseptic solution, a local anaesthetic injection, with or without steroid, will be injected into your skin. You may feel some discomfort when you are having the injection.

What happens after the procedure?

You should be able to swallow liquid without any problems before discharge.

You should continue to take your usual pain relief medication for a few days as the pain may be slightly worse until the injection starts to work.

What to expect when you return home

You may feel weak or tired  for a little while so we advise that you rest for 24 hours.

You should continue to take your usual pain relief medication for a few days as the pain may be slightly worse until the injection starts to work.

Remove any plasters the next day.

How long will the pain relief last?

This varies between the individuals.  Some might notice immediate pain relief where in others it may take up to one to two weeks.  However, pain relief may last from a few days to several months.  Some patients do not get any pain relief from a stellate ganglion block.

Follow up appointment

A letter will be sent to your doctor and you will be reviewed either by telephone or seen at the Pain Clinic in due course

At this review you will be asked to discuss the Pain Diary you were given at your injection appointment, please have this completed diary to hand at the time of the phone call.

Points to remember

• You will need to arrange for someone to drive you home after this procedure.
• Please bring your glasses if you need them for reading.
• Always bring a list of all current medication.
• Continue taking all your usual medication on treatment day.
• If there is any possibility you may be pregnant please inform the doctor or nurse.
• If you are planning to travel abroad or fly within two weeks after the injections, please let your doctor know as it may be best to change the date of the injections.

Additional Information

The information in this leaflet is not intended to replace the advice given to you by your doctor or the pain service looking after you. If you require more information or have any questions, please speak to your doctor or the Pain Medicine services that are looking after you.

If you experience unusual symptoms such as a marked increase in pain/swelling around an injection site, fever, severe headache, new symptoms of pins and needles, new muscle weakness in your arms, or you are very concerned about how you feel after the procedure, please contact your doctor.

In the event of an emergency and outside normal working hours (9.00am – 4.00pm) of the Pain Clinic please contact your own doctor,Local Walk In Clinic /Minor Injuries Unit.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Pain Service, Outpatients Department, East Riding Community Hospital, Beverley Pain Service (01482) 478868

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.