What is a Stellate Ganglion Block?
A Stellate Ganglion Block (SGB) is a specialised injection used to treat selected pain conditions affecting the face, neck, upper chest and upper limb, particularly when symptoms are thought to be related to an overactive sympathetic ("fight or flight") nervous system.
The stellate ganglion is a collection of sympathetic nerves located in the lower part of the neck. By injecting a small amount of local anaesthetic around this structure, the sympathetic nerves are temporarily blocked. This may help reduce pain, abnormal nerve signalling and other symptoms related to sympathetic nervous system dysfunction.
Although the exact mechanism is not fully understood, an SGB may help modulate an overactive sympathetic nervous system and interrupt persistent pain signalling in appropriately selected patients. Individual responses vary, and not everyone will experience the same degree of benefit.
What conditions do we offer this for?
- Refractory trigeminal neuralgia
- Whiplash-associated pain
- Post-herpetic neuralgia (shingles) affecting the face, neck or upper chest.
- Complex regional pain syndrome (CRPS) affecting the upper limb.
- Persistent pain following surgery or radiotherapy involving the head, neck or upper chest.
- Chronic facial, neck or upper limb pain where sympathetic nervous system involvement is suspected.
- Chronic pain associated with (PTSD) post-traumatic stress disorder; off-label use
Why is it done?
This procedure is carried out to:
- Modulate an overactive sympathetic ("fight or flight") nervous system, which may be contributing to persistent pain or other symptoms.
- Reduce pain, burning sensations and hypersensitivity associated with certain neuropathic pain conditions.
- Improve blood flow and temperature regulation in selected patients where sympathetic dysfunction is contributing to symptoms.
- Improve function, sleep and overall quality of life.
- Provide diagnostic information to help guide further treatment.
- Reduce symptoms related to autonomic overactivity, such as excessive sweating, flushing or temperature sensitivity.
What does the procedure involve?
- You will lie comfortably on your back with your neck slightly extended.
- The skin over the injection site will be cleaned with antiseptic solution, and a small amount of local anaesthetic will be used to numb the skin.
- Using ultrasound guidance (and occasionally X-ray guidance, depending on the clinical indication), a fine needle is carefully positioned adjacent to the stellate ganglion, usually at the level of the C6 vertebra.
- A small amount of local anaesthetic is then injected around the stellate ganglion to temporarily block the sympathetic nerves.
- The procedure usually takes 15–30 minutes and is performed as a day-case procedure, allowing you to return home the same day after a short period of observation.
Further evidence-based patient information is available from the Faculty of Pain Medicine (Royal College of Anaesthetists). Please click this link to access this resource.
Benefits
A successful stellate ganglion block may:
- Help "turn down the volume" of an overactive pain system by modulating the sympathetic ("fight or flight") nervous system.
- Reduce pain, tingling and other nerve-related symptoms.
- Improve comfort and function in the face, neck or upper limb.
- Support recovery in selected patients with post-herpetic neuralgia or persistent pain following radiotherapy.
- Improve sleep, mood and overall well-being in selected patients.
- Reduce the need for pain medications in some patients.
Individual responses vary. While some patients experience significant improvement, others may notice only limited benefit or no benefit at all. The first one or two injections are often considered a therapeutic trial to assess your response.
Side Effects
Very Common side effects
(may affect more than 1 in 10 patients):
- Drooping of the eyelid, a red or bloodshot eye, a smaller pupil, or warmth and flushing of the face (temporary Horner's syndrome). These changes are expected and usually resolve within a few hours.
- Nasal congestion, facial tingling, or a sensation of fullness in the head.
- Temporary soreness, bruising or discomfort.
Common side effects
(may affect up to 1 in 10 patients):
- Dizziness or light-headedness, particularly when standing up soon after the procedure.
- Temporary hoarseness of the voice or mild difficulty swallowing.
- Temporary numbness or weakness of the arm or hand on the side of the injection.
Uncommon side effects
(may affect up to 1 in 1,00 patients):
- Infection at the injection site
- Puncture of the lung (pneumothorax)
- Flushing or sweating on one side of the face
Rare side effects
(may affect up to 1 in 1,000 patients):
- Nerve injury or prolonged hoarseness
- Bleeding or haematoma
- Allergic reaction to the local anaesthetic
Aftercare Advice
- You will be monitored for a short period after the procedure and can usually go home the same day.
- Do not drive, operate machinery or sign important legal documents for 24 hours after the procedure.
- It is common to experience temporary effects such as drooping of the eyelid, facial warmth or redness, hoarseness of the voice, or mild difficulty swallowing. These are expected and usually resolve within a few hours as the local anaesthetic wears off.
- Mild soreness or bruising at the injection site may occur and usually settles within a few days.
- Resume your normal activities gradually over the next 24–48 hours, avoiding strenuous activity on the day of the procedure.
- A follow-up appointment will be arranged to assess your response and discuss any further treatment options if appropriate.
- Contact the clinic or seek urgent medical attention (at nearest A&E) if you develop increasing neck swelling, difficulty breathing, severe or persistent weakness, fever, or any other concerning symptoms after returning home.
In case of a medical emergency
Please attend your nearest Accident & Emergency (A&E) Department immediately, or call 999 if you experience any of the following after your procedure:
- Fever, chills, or increasing redness, swelling or discharge at the injection site (which may indicate an infection).
- Difficulty breathing, chest pain, or sudden shortness of breath.
- Severe or persistent hoarseness, or difficulty swallowing that does not improve as the local anaesthetic wears off.
- New or worsening weakness, numbness or drooping affecting the face or arm that persists beyond the expected duration of the local anaesthetic.
- Loss of bladder or bowel control.
- Severe pain that is worsening or not relieved by your usual pain medication.
A Stellate Ganglion Block (SGB) is a specialised injection used to treat selected pain conditions affecting the face, neck, upper chest and upper limb, particularly when symptoms are thought to be related to an overactive sympathetic (“fight or flight”) nervous system.
The stellate ganglion is a collection of sympathetic nerves located in the lower part of the neck. By injecting a small amount of local anaesthetic around this structure, the sympathetic nerves are temporarily blocked. This may help reduce pain, abnormal nerve signalling and other symptoms related to sympathetic nervous system dysfunction.
Although the exact mechanism is not fully understood, an SGB may help modulate an overactive sympathetic nervous system and interrupt persistent pain signalling in appropriately selected patients. Individual responses vary, and not everyone will experience the same degree of benefit.
What conditions do we offer this for?
- Refractory trigeminal neuralgia
- Whiplash-associated pain
- Post-herpetic neuralgia (shingles) affecting the face, neck or upper chest.
- Complex regional pain syndrome (CRPS) affecting the upper limb.
- Persistent pain following surgery or radiotherapy involving the head, neck or upper chest.
- Chronic facial, neck or upper limb pain where sympathetic nervous system involvement is suspected.
- Chronic pain associated with (PTSD) post-traumatic stress disorder; off-label use
Why is it done?
This procedure is carried out to:
- Modulate an overactive sympathetic (“fight or flight”) nervous system, which may be contributing to persistent pain or other symptoms.
- Reduce pain, burning sensations and hypersensitivity associated with certain neuropathic pain conditions.
- Improve blood flow and temperature regulation in selected patients where sympathetic dysfunction is contributing to symptoms.
- Improve function, sleep and overall quality of life.
- Provide diagnostic information to help guide further treatment.
- Reduce symptoms related to autonomic overactivity, such as excessive sweating, flushing or temperature sensitivity.
What does the procedure involve?
- You will lie comfortably on your back with your neck slightly extended.
- The skin over the injection site will be cleaned with antiseptic solution, and a small amount of local anaesthetic will be used to numb the skin.
- Using ultrasound guidance (and occasionally X-ray guidance, depending on the clinical indication), a fine needle is carefully positioned adjacent to the stellate ganglion, usually at the level of the C6 vertebra.
- A small amount of local anaesthetic is then injected around the stellate ganglion to temporarily block the sympathetic nerves.
- The procedure usually takes 15–30 minutes and is performed as a day-case procedure, allowing you to return home the same day after a short period of observation.
Further evidence-based patient information is available from the Faculty of Pain Medicine (Royal College of Anaesthetists). Please click this link to access this resource.