The most common indication for stellate ganglion block is complex regional pain syndrome of the upper extremity. Additional indications for stellate ganglion blockade include: neuropathic pain of the hand or arm, symptoms of menopause, refractory ventricular tachycardia, cardiac electrical storm, vascular insufficiency, hyperhidrosis, among others.
The stellate ganglion is formed by the fusion of the inferior cervical ganglion and first thoracic ganglion, normally located at the level of cervical vertebral body, C7. The target stellate ganglion blockade is most commonly the transverse process of C6 (Chassaignac's tubercle). Needle placement occurs at the level of C6 to avoid side effects of pneumothorax, nerve root injury and vascular injection.
Common side effects of stellate ganglion block are: Horner’s Syndrome (ptosis, miosis, anhidrosis, enophthalmos), Hoarseness (Recurrent Laryngeal Nerve), as well as Hemidiaphragm (Phrenic Nerve). Horner’s syndrome is by far the most commonly encountered side effect and is considered by some practitioners to be an indicator of successful blockade.