Blocking of these sympathetic nerves also causes the blood vessels in the arm to get wider (dilate). This will improve the blood supply in patients who have pain due to poor circulation. This is useful in conditions such as Raynaud's disease.
What has gone wrong?
Your sympathetic nerves have started sending pain messages. It is not at all clear why this happens. When this happens we can reduce the pain by blocking the activity of the sympathetic nerves.
The aim of the procedure is to reduce the signals sent by the sympathetic nerves and so reduce the pain. As stated, the procedure will also improve the circulation of the arm and may improve pain caused by ischaemia, which is a poor blood supply.
Your pain should be reduced and you should be able to move around more easily. If successful, the treatment can avoid the need for tablet medications.
Are there any alternatives?
By the time that you consider having the stellate ganglion block you should have already tried other more simple treatments. These include rest and both painkilling and anti-inflammatory tablets.
You may have also tried a transcutaneous electrical nerve stimulation (TENS) machine for the pain. This works by sending soothing pulses across the surface of the skin and along the nerve fibres. The pulses prevent pain signals reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
What if you do nothing?
If you do nothing there are several things that may happen:
With time and rest the pain may settle on its own
The pain and difficulty in performing daily activities may remain the same
The pain may increase and spread
The pain may cause your posture to get worse, making daily activities and even sleeping more difficult
Who should have it done?
The following groups of patients should have the procedure done:
Patients with pain in the area covered by the stellate ganglion, which has failed to respond to standard treatments. The pain could be in the head, face, neck, arm or heart
Patients with pain in the area covered by the stellate ganglion, with symptoms suggesting that the sympathetic nerves are involved
Who should not have it done?
Each patient has the final decision on whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.
There are specific medical situations when a stellate ganglion block should not be done and they are as follows:
When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor
When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal
When there is infection of the skin over the site where the needle needs to be put in. This could lead to infection in the deeper tissues
Author: Dr Sean White FRCA. Consultant in pain and anaesthesia.
© Dumas Ltd 2006