What is the role of cervicothoracic sympathetic block in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

Cervicothoracic sympathetic block is also referred to as "stellate ganglion block;" and it usually is performed by an experienced anesthesiologist for the indications previously outlined. Using the technique described by Brown, the patient is placed in supine position with the neck in slight extension. The operator then identifies the sixth cervical vertebral tubercle by locating the cricoid cartilage and moving the fingers laterally until they reach this easily palpable structure. The anesthesiologist then places the index and third fingers between the carotid artery laterally and the trachea medially at the level of C6. A short 22- or 25-gauge needle is inserted until it contacts the transverse process of C6. The needle is then withdrawn approximately 1-2 mm and 5-10 mL of LA injected. Care must be taken not to perform intravascular injection or LA blockade of the recurrent laryngeal and phrenic nerves.

Schematic anatomical representations, sympathetic Schematic anatomical representations, sympathetic chain and stellate ganglion.
Cervical and superior thoracic anatomy (anterolate Cervical and superior thoracic anatomy (anterolateral view).
Stellate block, important anatomical landmarks (su Stellate block, important anatomical landmarks (surface and cross-sectional views).
Stellate block technique and anatomy. See text for Stellate block technique and anatomy. See text for details.

Blockade of the thoracic sympathetic chain is a useful diagnostic and therapeutic procedure for identifying segmental nociceptive pathways, which may be causing pain due to inflammatory, infectious (herpes zoster), or structural pathology. Celiac plexus block should be performed by a skilled anesthesiologist for relieving severe pain caused by an acute visceral disease. Using the technique described by Brown, the patient is placed in prone position over a pillow placed beneath the abdomen to reduce lumbar lordosis.


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