Stellate Ganglion Block

  • CRPS, RSD, Causalgia, Raynaud’s, Accidental intraarterial injections, acute herpes zoster of the face and lower cervical and upper thoracic dermatomes, pulmonary embolism
  • Supplies sympathetic innervation to the user extremity through the gray communicating rami of C7, C8 and T1 (occaisionally C5 and C6).  
  • In some patients, T2 and T3 gray communicating rami innervate the distal upper extremity and do not pass through the ganglion (hence sympathetically mediated pain not relieved with satisfactory stellate ganglion block)
  • CPT 64510, 76942


  • Pain Syndromes
  •  Complex Regional Pain Syndrome Type I and II
  •  Refractory Angina
  •  Phantom Limb Pain 
  • Vascular Insufficiency
  •  Raynaud's Syndrome
  •  Scleroderma
  •  Frostbite
  •  Obliterative vascular disease
  •  Vasospasm
  •  Trauma
  •  Emboli
  •  S/P vascular reconstruction, limb reimplantation
  • Edema
  •  local edema s/p surgery



  • Hematoma from vascular trauma
  •  Carotid trauma
  •  Internal jugular vein trauma
  •  Neural injury
  • Vagus
  • Brachial plexus roots
  • Pulmonary injury
  •  Pneumothorax
  •  Hemothorax
  •  Chylothorax (thoracic duct injury)
  •  Other
  •  Esophageal perforation


  • Intravascular injection
  •  Carotid artery
  •  Vertebral artery
  •  Internal jugular vein
  •  Neuraxial/brachial plexus spread
  •  Epidural block
  •  Intrathecal
  •  Brachial plexus anesthesia or injury (intraneural injection)
  •  Local spread
  •  horseness (recurrent laryngeal nerve)
  •  elevated hemidiaphragm (phrenic nerve)


INFECTION (esophageal perforation is a predisposing factor)

  •  Soft tissue (abscess)
  •  Neuraxial (meningitis)
  •  (osteitis)

Ultrasound Guided Stellate Ganglion

Superior thyroid artery


Lateral Approach

Stellate Ganglion Block


  • Anticoagulation therapy
  • Pneumothorax (and pneumonectomy on contralateral side, 
  • Recent cardiac infarction because the stellate ganglion cuts off the cardiac sympathetic fibers (accelerator nerves) 
  • Glaucoma is a relative contraindication (provocation of glaucoma by repeated stellate ganglion block has been reported).
  • Caution with atrioventricular block and impairment of cardiac stimulus conduction as well.


  • Pneumothorax, 
  • Neuraxial injection
  • Phrenic and brachial plexus block
  • Cervical nerve root puncture/ block
  • Cocal cord paralysis, 
  • Vascular puncture (superior thyroid artery,vertebral artery, carotic artery etc.)
  • Hematoma
  • Esophageal perforation
  • Using the classic (blind or flouroscopic) approach, the superior thyroid artery may be punctured or transected. An ultrasound in the hands of a skilled physician may identify the structure so that it can be avoided.

Course Calendar & Discounts

Sign up for Live and Online Training Events, Coupons, Free Educational Content and more!

Thank You


and Interesting Articles

  • Piraccini E, Munakomi S, Chang KV. Stellate Ganglion Blocks. [Updated 2022 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • McLean B. Safety and Patient Acceptability of Stellate Ganglion Blockade as a Treatment Adjunct for Combat-Related Post-Traumatic Stress Disorder: A Quality Assurance Initiative. Cureus. 2015 Sep 10;7(9):e320. doi: 10.7759/cureus.320. PMID: 26487996; PMCID: PMC4601906.

  • Wang D. Image Guidance Technologies for Interventional Pain Procedures: Ultrasound, Fluoroscopy, and CT. Curr Pain Headache Rep. 2018 Jan 26;22(1):6. doi: 10.1007/s11916-018-0660-1. PMID: 29374352.

  • Duong S, Bravo D, Todd KJ, Finlayson RJ, Tran Q. Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis. Can J Anaesth. 2018 Jun;65(6):658-684. English. doi: 10.1007/s12630-018-1091-5. Epub 2018 Feb 28. PMID: 29492826.

  • Datta R, Agrawal J, Sharma A, Rathore VS, Datta S. A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body. J Anaesthesiol Clin Pharmacol. 2017 Oct-Dec;33(4):534-540. doi: 10.4103/joacp.JOACP_326_16. PMID: 29416250; PMCID: PMC5791271.


Continuing Medical Education and Board Review

This Podcast, website and any content from NRAP Academy ( otherwise known as, LLC is  for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Check out our other CME Board Reviews!