From the Guidelines
A stellate ganglion block may be considered as a potential treatment option for patients with long COVID experiencing dysautonomia symptoms, as two patients in a pilot study experienced substantial alleviation of symptoms following the procedure. This procedure involves injecting local anesthetic around the stellate ganglion, a collection of sympathetic nerves located in the neck, and is primarily used to treat pain conditions affecting the head, neck, upper chest, and arms. The use of stellate ganglion block in long COVID patients is based on a study published in 2023 1, which noted the potential benefits of this procedure in alleviating dysautonomia symptoms.
Key points to consider when evaluating the use of stellate ganglion block in long COVID patients include:
- The procedure typically uses local anesthetics like lidocaine or bupivacaine, sometimes combined with steroids
- The injection is performed under imaging guidance to ensure accurate placement
- Patients may experience temporary side effects, including Horner's syndrome, hoarseness, and difficulty swallowing
- The pain relief from a single injection typically lasts hours to days, but some patients experience longer benefits
It is essential to note that the evidence for the use of stellate ganglion block in long COVID patients is limited to a small pilot study, and further research is needed to fully understand its potential benefits and risks. However, based on the available evidence, stellate ganglion block may be a viable treatment option for patients with long COVID experiencing dysautonomia symptoms, and should be considered in conjunction with other treatment strategies. As noted in the study published in 2023 1, the development of effective treatments for long COVID is crucial, and stellate ganglion block may be a promising avenue for further research.
From the Research
Overview of Stellar Ganglion Block
- The stellar ganglion block is a procedure used to diagnose and treat various conditions, including chronic pain, refractory ventricular arrhythmias, and sympathetically maintained pain syndromes 2, 3, 4, 5, 6.
- The block involves the injection of a local anesthetic, such as bupivacaine, into the stellate ganglion, which is located in the neck 2, 3, 4, 5, 6.
Efficacy of Stellar Ganglion Block
- Studies have shown that the stellar ganglion block can be an effective treatment for various conditions, including chronic pain and refractory ventricular arrhythmias 2, 3, 4, 5.
- The efficacy of the block can be assessed by evaluating the effects on vasoconstrictor and sudomotor fibers, as well as changes in skin temperature, skin blood flow, and skin resistance response 2.
- The use of long-acting liposomal bupivacaine can result in a more prolonged effect compared to traditional bupivacaine hydrochloride 3.
Techniques for Stellar Ganglion Block
- Various techniques can be used to perform the stellar ganglion block, including the blind technique, fluoroscopy, and ultrasound-guided approach 6.
- The ultrasound-guided approach has been shown to be safe and effective, allowing for direct visualization of vascular structures and soft tissue structures, and minimizing the risk of injury 6.
- The ideal placement of the needle tip should be anterolateral to the longus colli muscle, deep to the prevertebral fascia, but superficial to the fascia investing the longus colli muscle 6.
Safety and Complications
- The stellar ganglion block is generally considered safe, but complications can occur, including vascular and soft tissue injury 6.
- The use of ultrasound guidance can help minimize the risk of complications by allowing for direct visualization of vascular structures and soft tissue structures 6.
- Repeated blocks can provide additional benefits, and the procedure can be performed with minimal risk of complications 4.