Stellate Block

Published on 06/02/2015 by admin

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Last modified 06/02/2015

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26 Stellate Block

Perspective

The primary use of stellate block is in the diagnosis and treatment of complex regional pain syndromes of the upper extremity. It may also be used in clinical situations when increased perfusion to the upper extremity is desired, although this can also be accomplished with the brachial plexus blocks.

Patient Selection

Patients for this block are primarily those with complex regional pain syndromes of the upper extremity or those with impaired perfusion to the upper extremity after trauma.

Pharmacologic Choice

Even during diagnostic use of stellate ganglion block, it is often desirable to produce a long-lasting block. Therefore, a solution of 0.25% bupivacaine, or 0.2% ropivacaine with 1:200,000 epinephrine is often my first choice.

Placement

Anatomy

The cervical sympathetic trunk is a cephalad continuation of the thoracic sympathetic trunk. It is composed of three ganglia: the superior cervical ganglion, generally opposite the first cervical vertebra; the middle cervical ganglion, usually opposite the sixth cervical vertebra; and the stellate (cervicothoracic) ganglion, generally opposite the seventh cervical and first thoracic vertebrae near the head of the first rib. The stellate ganglion is a fusion of the inferior cervical ganglion and the first thoracic ganglion—hence the name cervicothoracic ganglion (Fig. 26-1

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