Stellate blockade is a targeted locally applied conduction anesthesia in the area of the stellate ganglion to relieve vasospasm in the form of arteriovenous spasm. In this process, the blood vessels in question are sympathetically innervated and vasodilation occurs within the entire area. In other words, the blood vessels dilate, decongest, there is a decrease in sweat secretion, and successful treatment reveals the so-called Horner syndrome.
What is stellate blockade?
The stellate ganglion, (from the Latin stellatum = star-shaped) is a star-shaped nerve cord of the neck. This ganglion provides regulation of the autonomic nervous system. During stellate blockade, an anesthetic is injected at this nerve cord with the goal of relieving the patient in question of pain as much as possible. Ganglionic opioid analgesia is also possible at the same site. This provides both short-term and long-term pain relief.
Function, effect, and goals
Stellate blockade can be used for a wide range of conditions and injuries associated with severe pain in the head and neck. These include migraine, unilateral headache, whiplash, traumatic brain injury, trigeminal neuralgia, or facial erysipelas caused by herpes zoster, which may also be associated with prolonged severe pain in some patients. Other areas of application include periarthritis of the shoulder joint known as “frozen shoulder“, osteochondrosis of the cervical spine, and Raynaud’s disease. In addition, stellate blockade can help with phantom limb pain, which is common after amputations. Since the stellate ganglion is a nerve node from which nerve cords emanate in a star shape, the blockade is also used to diagnose unclear pain conditions. Pain usually occurs in the case of tissue damage or in the case of various diseases. Sometimes, however, no cause can be identified. The pain can be of varying intensity from mild to severe or unbearable, anything is possible. The quality of the pain can be described as sharp or dull and sometimes a chronic pain syndrome develops. Modern medicine relies on good pain management, through medication, acupuncture, autogenic training and psychotherapy or physiotherapy. Sometimes psychotherapy and medication are used together. Only when all this is not helpful, after a whole series of examinations, the stellate blockade is used. On the day of treatment, patients should have eaten only small and light meals and, if possible, only tea or water until six hours before the stellate blockade. After that, eating, drinking and smoking are prohibited for medical reasons, because otherwise complications and interactions with the medications used may increase. In addition, if possible, cosmetics should no longer be used. All piercings as well as contact lenses and removable dentures must be removed beforehand. In most cases, several individual sessions are necessary for optimal results. If possible, these are performed under outpatient conditions. First, a venous access is placed in the patient’s mouth so that a medication can be administered if necessary in case of allergic or other negative reactions of the body. Then, an anesthetic is injected into the front of the neck near the nerve node. This is usually no more painful than any normal insertion through a medical needle. When a ganglionic opioid analgesia is performed, an opioid is also injected. However, this can be injected as the sole pain reliever. After treatment, there is heating on the side of the injection in the shoulder and arm area and the side of the face. Sometimes the injected painkiller also causes swelling of the nasal mucosa, as well as a constricted pupil and drooping eyelid. The procedure may be accompanied by ultrasound or X-ray to check that the correct area is being hit. Complete anesthesia takes effect after about fifteen minutes and lasts for several hours. Electrostimulation may be performed at the same time during the session.
Risks, side effects and dangers
Of course, stellate blockade also carries certain risks, just like any other surgical procedure.Most frequently, allergic reactions of any severity up to and including anaphylactic shock, bruising, and bleeding or postoperative hemorrhage may occur. Less frequently, inflammation or abscesses occur due to encapsulated inflammatory foci. Dead tissue sites and nerve irritation cannot be completely ruled out, but are very rare, as are subsequent infections or sepsis (blood poisoning). Accidental damage to a nerve can result in paralysis or sensory disturbances. If an artery is accidentally hit, the effect may be amplified or cause further complications. An extremely rare puncture of the lung may interfere with breathing by causing air to accumulate between the chest wall and the lungs. Equally rare, the effect may penetrate to the spinal cord. Sometimes a tightness in the throat, hoarseness, or nausea and vomiting occur. Side effects of opioids can include fatigue, skin itching, urinary retention or constipation. These are some main risks, but the exact advice can only be given by the treating physician. After an outpatient stellate blockade, patients should not drive a vehicle or operate machinery for at least 24 hours. They should have someone pick them up and, if possible, not be alone during the initial period. It is essential to discuss the intake of any medications with the doctor beforehand to avoid dangerous interactions. In case of complications, a doctor should be consulted immediately.
