Ultrasound-guided stellate ganglion block is useful in the diagnosis and treatment of a variety of painful conditions, including reflex sympathetic dystrophy of the face and upper extremity, causalgia involving the upper extremity, acute herpes zoster in the distribution of the trigeminal nerve and cervical and upper thoracic dermatomes, hyperhidrosis, phantom limb pain, postmyocardial sympathetically mediated pain, sympathetically mediated pain of malignant origin, and sudden idiopathic sensorineural hearing loss. Ultrasound-guided stellate ganglion block is useful in the diagnosis and treatment of a number of diseases that have in common their ability to cause acute vascular insufficiency. These diseases include acute frostbite, acute angina, ergotism, obliterative vascular disease, Raynaud disease, scleroderma, vasospastic disorders, posttraumatic vascular insufficiency, and embolic phenomenon (Fig. 25.1; Table 25.1). Stellate ganglion block can also help decrease the autonomic instability associated with acute tetanus infection. Ultrasound-guided stellate ganglion block can also be used in a prognostic manner to determine the effect of blockade of the stellate ganglion prior to surgical sympathectomy in the cervical and upper thoracic region.

The stellate ganglion, which is also known as the cervicothoracic or inferior cervical ganglion, is formed by the fusion of the inferior cervical and first thoracic sympathetic ganglia. The stellate ganglion is located on the anterior surface of the longus colli muscle (Fig. 25.2). This muscle lies just anterior to the transverse processes of the seventh cervical and first thoracic vertebrae (Fig. 25.3). The stellate ganglion lies anteromedial to the vertebral artery and is medial to the common carotid artery and jugular vein (Fig. 25.4). The stellate ganglion is lateral to the trachea and esophagus. Although the stellate ganglion is located at the level of the seventh cervical and first thoracic vertebrae, when using the landmark technique, it is most commonly blocked at the C6 level to avoid the possibility of pneumothorax as the dome of the lung lies at the C7-T1 interspace in many patients (Fig. 25.5).

The patient is placed in the supine position with the head turned slightly away from the side to be blocked. Turning the head has the dual advantages of (1) increasing distance between the trachea and the carotid artery and (2) improving the view of the anatomy on ultrasound imaging. Seven milliliters of local anesthetic is drawn up in a 10-mL sterile syringe, and 40 to 80 mg of depot steroid is added to the local anesthetic if there is thought to be an inflammatory component to the patient’s pain symptomatology.

The medial border of the sternocleidomastoid muscle at the level of the cricothyroid notch is identified by palpation. A high-frequency linear ultrasound transducer is then placed over


medial border of the sternocleidomastoid muscle in the transverse position at the level of the cricoid notch, which should place the transducer at approximately the C6 level (Fig. 25.6).