Stroke: A complication of stellate ganglion block

Abstract

Stellate ganglion block (SGB) is a procedure wherein local anesthetic is injected to block the nerves of the lower cervical and upper thoracic sympathetic chain. Although the procedure historically had been performed using a blind technique, SGBs are now almost universally performed under either fluoroscopic or ultrasound guidance. Indications for this procedure are myriad and include complex regional pain syndrome (CRPS) of the upper extremities, poststroke pain, vascular headache, post traumatic stress disorder (PTSD), hearing loss, and vasomotor instability associated with menopause, among others. SGBs carry a greater risk of morbidity than typical interventional pain procedures and include recurrent laryngeal nerve block, phrenic nerve paralysis, hypotension, seizure, pneumothorax, retropharyngeal hematoma, and stroke. Although the safety profile of SGB has improved with the advent of fluoroscopic guidance and should improve further with the increasing use of ultrasound guidance, the risk of adverse outcomes remains present.