Epidural Steroid Injection
Stellate Ganglion Injection is an injection of local anesthetic in the “sympathetic nerve tissue”- the nerves which are a part of Sympathetic Nervous System. The nerves are located on either side of the voice box, in the neck.
What is the purpose of it?
The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving upper extremity or head and face.
How long does the procedure take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a local anesthetic (usually ropivicaine).
Will the procedure hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). There is some discomfort involved. We may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Some of the patients also receive intravenous sedation and analgesia, which may make the procedure easier to tolerate.
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. Rarely patients also receive intravenous sedation and analgesia, which may make the procedure easier to tolerate.
How is it actually performed?
You will either be laying flat or slightly sitting up. Chin is slightly raised. The skin in the front of the neck, next to the “voice box” is cleaned with antiseptic solution and then the injection is carried out.
What should I expect after the procedure?
Immediate after the injection, you may feel your upper extremity getting warm. In addition, you may notice that your pain may be gone or considerably less. You may also notice a “lump in the throat” as well as hoarse voice, droopy and red eye and some nasal congestion on the side of the injection. You may also develop a temporary headache.
What should I do after the procedure?
You should have a ride home. We advise you to take it easy for a day or so after the procedure. Perform your normal activities. As you can tolerate them. Some Patients may go for immediate physical therapy.
Can I go to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck at the injection site.
How long will the effects of the procedure last?
The local anesthetic wears off in a few hours. However, the blockage of sympathetic nerves may last for many more hours – it may take up to 8 hours for the droopy eyelid to go away for example.. Usually the duration of relief gets longer after each injection. Duration of pain relief can be from a day to many months
How many injections do I need to have?
If you respond to the first injection, repeat injections are usually in your best interest. Usually a series of such injections is needed to treat the problem. Some may need 2 or more. The response to such injections varies from patient to patient.
Will the Stellate Ganglion Injection help me?
It is very difficult to predict if the injection(s) will indeed help you or not. The patients who are treated earlier during their illness tend to respond better than those who have this treatment after about six months of symptoms do. Patients in the advanced stages of disease may not respond adequately.
What are the risks and side effects?
This procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain- which is temporary. The risk involves bleeding, infection, spinal block, epidural block and injection into blood vessels and surrounding organs. Fortunately the serious side effects and complications are uncommon.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin, Plavix, Pradaxa, Lovenox, or Heparin), if you have an active infection going on near the injection sited, or if you are pregnant you should not have the injection.