From the Guidelines
Stellate ganglion block cannot be recommended in the rotator cuff repair setting due to a lack of procedure-specific evidence and increased risk of complications. When considering the use of a stellate ganglion block, it is essential to weigh the potential benefits against the risks, particularly in the context of rotator cuff repair surgery. According to the guideline for pain management after rotator cuff repair surgery by Toma et al. 1, there is limited procedure-specific evidence to support the use of stellate ganglion block in this setting.
Some key points to consider when evaluating the use of stellate ganglion block include:
- The lack of procedure-specific evidence to support its use in rotator cuff repair surgery 1
- The increased risk of complications associated with the procedure, such as seizures, pneumothorax, or intravascular injection
- The availability of alternative pain management strategies, such as suprascapular nerve block or interscalene block, which have been shown to be effective in reducing pain scores and opioid use after surgery 1
In terms of the technical aspects of the procedure, a stellate ganglion block typically involves injecting local anesthetic around the stellate ganglion under fluoroscopic or ultrasound guidance. However, the specifics of the procedure are not as relevant in this context, given the lack of evidence to support its use in rotator cuff repair surgery.
Overall, the decision to use a stellate ganglion block should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, as well as the potential risks and benefits of the procedure. However, based on the current evidence, it is not recommended to use stellate ganglion block in the rotator cuff repair setting 1.
From the Research
Stellate Ganglion Block Overview
- The stellate ganglion block (SGB) is a procedure used to treat various conditions, including chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD) 2.
- The mechanism of action of SGB is still uncertain, but it is believed to involve the reduction of nerve growth factor (NGF) and norepinephrine (NR) levels, leading to a decrease in symptoms 2, 3.
Efficacy of Stellate Ganglion Block
- Studies have shown that SGB is effective in reducing pain in patients with CRPS, with a mean pain reduction of 73.2% and 55.8% for spontaneous and provoked pain, respectively 4.
- SGB has also been shown to improve functional outcomes, such as range of motion and disability, in patients with CRPS 4, 5.
- A review of SGB as an adjunctive treatment modality found that it has promising evidence-based results for various conditions, including anosmia, PTSD, long-COVID, chronic fatigue syndrome, menopausal hot flashes, and ventricular tachyarrhythmias 3.
Comparison with Other Treatments
- A study comparing continuous stellate ganglion block with continuous infraclavicular brachial plexus block found that both treatments were effective in managing CRPS type I of the upper extremity, but with some differences in outcome measures 5.
- Another study found that CT-guided radiofrequency neurolysis of the stellate ganglion was more effective than stellate ganglion blockade in managing chronic refractory type I CRPS of the upper limb, with a significantly higher success rate (67.6% vs 21.2%) 6.
Safety and Complications
- SGB is generally considered safe, with minor and self-limiting complications, such as hoarseness, dysphagia, local hematoma, and ipsilateral brachial plexus block, occurring in 11.5% of patients 4.
- Rare complications, such as contralateral Horner's syndrome and pneumothorax, have also been reported 4, 6.