For a left‑sided oral mass, which side stellate ganglion block—left or right—provides the most effective analgesia?

Stellate Ganglion Block for Left Oral Mass: Ipsilateral (Left-Sided) Block Recommended

For a left-sided oral mass, perform a left stellate ganglion block (ipsilateral to the lesion) to achieve effective analgesia, as stellate ganglion blockade produces sympathetic denervation affecting the head, neck, and upper extremity on the same side as the block is performed. 1

Anatomical Rationale

The stellate ganglion block produces a unilateral sympathetic blockade that affects structures on the ipsilateral side only 1:

• The block affects one side of the head and neck, plus the upper extremity and upper thorax on the same side where the injection is performed 1
• The stellate ganglion consists of the fusion of the sixth and seventh cervical vertebrae and first thoracic sympathetic ganglia, controlling sympathetic innervation to ipsilateral head and neck structures 2
• There is no contralateral effect from stellate ganglion blockade—the sympathetic chain does not cross midline at this level 1

Clinical Application for Oral Masses

For pain management of a left oral mass:

• Perform the left stellate ganglion block to target sympathetic-mediated pain components in the left oral cavity 1, 2
• The mechanism involves reducing nerve growth factor (NGF) and sympathetic sprouting, subsequently lowering norepinephrine levels in the affected region 3
• This addresses the sympathetic hyperactivity component that contributes to chronic pain in head and neck pathology 3

Technical Considerations

When performing the block 4, 5:

• Use image guidance (fluoroscopy or ultrasound) to reduce complications including pneumothorax risk 4
• Employ standard aseptic technique similar to neuraxial procedures 4
• Calculate the lowest effective dose of local anesthetic based on patient weight to avoid systemic toxicity 4
• Monitor blood pressure and electrocardiogram, especially in high cardiovascular risk patients 4

Critical Safety Points

The complication rate is approximately 1.7 per 1000 blocks, with most being CNS complications 6:

• Always perform aspiration tests before injection to avoid inadvertent subarachnoid or intra-arterial injection 6
• Have an assistant present with anticonvulsant drugs and resuscitation equipment immediately available 6
• Place an intravenous line and use ECG monitoring 6
• Administer a test dose of 0.5-2 ml local anesthetic before full injection 6

Common pitfall: Do not perform a right stellate ganglion block for left-sided pathology, as this will not provide sympathetic blockade to the affected area due to the unilateral nature of sympathetic chain anatomy 1.