Stellate Ganglion Block

Aka: Stellate Ganglion Block

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II. Indications

  1. Emergency Department
    1. Refractory Ventricular Dysrhythmia (e.g. electrical storm Ventricular Tachycardia)
  2. Other uses by Anesthesiology
    1. Upper extremity Pain Disorders (see Supraclavicular Nerve Block)
    2. Post-Traumatic Stress Disorder

III. Contraindications

  1. No absolute contraindications in refractory Cardiac Arrest
  2. Anesthetic agent Anaphylaxis
  3. Anticoagulation (elective procedures)

IV. Complications

  1. Local Anesthetic Systemic Toxicity (LAST Reaction)
    1. Calculate the maximum safe Anesthetic dose in elective procedures
    2. In Refractory Ventricular Dysrhythmia, Lidocaine 1% 10 ml is typically most available and safe dose in adults
  2. Horner Syndrome
  3. Pneumothorax
  4. Seizures
  5. Large vessel injury (e.g. Carotid Artery, Vertebral Artery)

V. Technique: Ultrasound Guided Block (preferred)

  1. Patient head is turned to the right, exposing the left neck
  2. Ultrasound linear probe placed transverse over the anterior neck at the cricoid cartilage
    1. Consider applying color doppler to identify nearby vessels (e.g. Carotid Artery, Vertebral Artery)
  3. Identify the longus coli Muscle body
    1. Ultrasound landmark that allows safer lateral needle approach
    2. Longus coli Muscle lies deep to the Carotid Artery
    3. Stellate Ganglion lies above (superficial) the Longus coli Muscle
  4. Insert the needle in-plane to the Ultrasound probe toward the stellate Ganglion
    1. Target Ganglion is between the Carotid Artery (superficial) and the longus coli Muscle (deep)
  5. Aspirate and Inject Local Anesthetic
    1. Inject around the stellate Ganglion (but NOT in the Ganglion)
  6. Consider repeating procedure on the right side
    1. Indicated in persistent Refractory Ventricular Dysrhythmia despite left sided Stellate Ganglion Block

VI. Technique: Landmark-Based Block

  1. Patient's head is positioned looking straight ahead
  2. Identify the C6 tubercle or transverse process on the left side of the neck
    1. Lateral to the midline (by few centimeters) at level of cricoid cartilage
    2. Palpate the C6 tubercle with non-dominant hand
      1. Displace the overlying Sternocleidomastoid Muscle
    3. Carotid will be lateral to the position of the C6 tubercle
  3. Insert needle
    1. Direct the needle perpendicular to the C6 tubercle toward the midline
    2. Retract needle 1-2 mm and aspirate, then inject
  4. Consider repeating procedure on the right side
    1. Indicated in persistent Refractory Ventricular Dysrhythmia despite left sided Stellate Ganglion Block

VII. Resources

  1. Stellate Ganglion Block (Nysora)
    1. https://www.nysora.com/pain-management/ultrasound-guided-cervical-sympathetic-block/
  2. Stellate Ganglion Block (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK507798/
  3. Stellate Ganglion Block (ASRA)
    1. https://asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/06/stellate-ganglion-block

VIII. References

  1. Warrington (2026) Crit Dec Emerg Med 40(7): 20-1

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