Chapter 38 - Stellate Ganglion Block: Radiofrequency Lesioning

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. Radiofrequency lesioning of the stellate or cervicothoracic ganglion is indicated in the treatment of sympathetically mediated pain when the pain has repeatedly responded to stellate ganglion block with local anesthetic, but the pain relief is not long lasting. Pain syndromes that may be amenable to radiofrequency lesioning of the stellate ganglion include vascular insufficiency of the face and upper extremities; reflex sympathetic dystrophy of the face, neck, upper extremity, and upper thorax; Raynaud's syndrome or Berger's disease of the upper extremities; and sympathetically mediated pain of malignant origin.