Chapter 37 - Stellate Ganglion Block: Vertebral Body Approach

Abstract

The stellate ganglion, which is also known as the inferior cervical ganglion, is located on the anterior surface of the longus colli muscle. This muscle lies just anterior to the transverse processes of the seventh cervical and first thoracic vertebrae. The stellate ganglion is made up of the fused portion of the seventh cervical and first thoracic sympathetic ganglia. The stellate ganglion lies anteromedial to the vertebral artery and is medial to the common carotid artery and jugular vein. The stellate ganglion is lateral to the trachea and esophagus. Stellate ganglion block is indicated in the treatment of acute herpes zoster in the distribution of the trigeminal nerve and cervical and upper thoracic dermatomes as well as frostbite and acute vascular insufficiency of the face and upper extremities. Stellate ganglion block is also indicated in the treatment of reflex sympathetic dystrophy of the face, neck, upper extremity, and upper thorax; Raynaud's syndrome of the upper extremities; and sympathetically mediated pain of malignant origin. Stellate ganglion block using the vertebral body approach is indicated when neurolysis of the stellate ganglion is being considered. The major advantage of this approach over the traditional anterior approach is that the placement of the needle tip against the junction of the transverse process and vertebral body decreases the possibility of inadvertent lysis of the somatic nerve roots, the phrenic nerve, or the recurrent laryngeal nerve. The disadvantage of this approach compared with the posterior approach to stellate ganglion block is the higher incidence of permanent Horner's syndrome.