A stellate ganglion block is an image-guided injection that calms the sympathetic nerves in the neck to ease complex regional pain syndrome and certain other pain conditions affecting the head, neck, and arm.
OVERVIEW
What it is and how it works
The stellate ganglion is a small cluster of sympathetic nerves on either side of the lower neck, near the base of the cervical spine. These nerves are part of the body’s “fight-or-flight” sympathetic system, and they help regulate blood flow, sweating, and pain signaling in the head, neck, and upper extremity. In some pain conditions, this sympathetic activity becomes overactive and contributes to persistent burning pain, swelling, and temperature or color changes in the affected limb.
During a stellate ganglion block, one of our physicians uses imaging guidance to place a thin needle near the ganglion on one side of the neck and inject a local anesthetic, sometimes combined with other medication. The anesthetic temporarily interrupts the sympathetic nerve signals. A well-placed block often produces a warm, flushed feeling in the arm and a temporary droopy eyelid, slightly smaller pupil, and nasal congestion on that side (Horner syndrome) — these expected, short-lived signs confirm the block reached the target nerves.
This procedure can be both diagnostic — helping confirm whether your pain is driven by the sympathetic nervous system — and therapeutic, providing pain relief and a window for rehabilitation. It is one of several plexus & ganglion blocks we perform at Columbia Pain & Spine Institute.
Commonly treats
WHAT TO EXPECT
Before, during, and after your procedure
Before
Your physician will review your symptoms, exam, and any prior imaging to confirm a sympathetic block is appropriate. Tell us about blood thinners, allergies, and your medications, since some may need to be adjusted beforehand. The procedure is performed on an outpatient basis, and you will need someone to drive you home.
During
You lie on your back with your neck slightly extended. After cleaning and numbing the skin, the physician uses fluoroscopy or ultrasound guidance to direct the needle precisely to the stellate ganglion and confirm placement before injecting. The injection itself typically takes only a few minutes, and the full visit is usually well under an hour.
After
We monitor you briefly for the expected signs of a successful block, such as warmth in the arm or the temporary Horner syndrome described above. You may notice a hoarse voice or mild swallowing changes for a short time, which resolve as the anesthetic wears off. Most people rest the remainder of the day and resume normal activity the next day.
Recovery & results
Any numbing or warmth from the local anesthetic fades within hours, while pain relief may build and last longer than the anesthetic itself. Because responses vary, your physician may recommend a short series of blocks combined with physical or occupational therapy to reinforce improvement.
FAQ
Common questions
Does a stellate ganglion block hurt?
The skin is numbed first, so most patients feel pressure rather than sharp pain during the injection. The temporary droopy eyelid, flushed face, and warm arm afterward are expected effects of the block, not complications, and they wear off as the medication does.
How many blocks will I need?
It varies. A single block may be used diagnostically to see whether your pain is sympathetically driven. If it helps, your physician may recommend a series of blocks paired with therapy. There is no fixed number — your response guides the plan.
How is this different from other sympathetic blocks?
The stellate ganglion governs the head, neck, and upper limb. Pain elsewhere is treated through different targets — for example a celiac plexus block for upper-abdominal pain or a hypogastric plexus block for pelvic pain. For nerve-related arm pain, a brachial plexus block may be considered instead.
Talk with our pain specialists
If you have burning pain, swelling, or color and temperature changes in your arm, hand, or face, a stellate ganglion block may be part of your care plan. Explore our full range of interventional pain services or learn more about related plexus & ganglion blocks. To ask whether this procedure is right for you, please contact our Gresham and Portland, Oregon offices.
Contact Columbia Pain & Spine Institute