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Stellate Ganglion Block

PREOPERATIVE DIAGNOSIS: Complex Regional Pain Syndrome, right upper extremity.

POSTOPERATIVE DIAGNOSIS: Same.

OPERATION: Stellate ganglion block.

ANESTHESIA: Local and sedation.

COMPLICATIONS: None.

DESCRIPTION OF PROCEDURE: The procedure risks and hazards were discussed with the patient and a proper consent was obtained. The patient was monitored by appropriately and then placed in a supine position on a fluoroscopy table with a shoulder roll in place with the cervical spine in a slightly extended position, as much as tolerated. The affected side was prepped with antiseptic solution and draped in a sterile classical fashion.

The cricoid cartilage is palpated and the fingertips are moved laterally, displacing the sternocleidomastoid and the carotid sheath laterally. Chassaignac’s tubercle, the transverse process of the 6th cervical vertebra, is identified under fluoroscopic control palpated and then isolated between two palpating fingertips. Once the carotid sheath is out of the way, a 22-gauge needle is inserted perpendicularly to all planes and placed on the anterior lateral border of the C-6 vertebral body and then withdrawn 1-2 millimeters before a negative aspiration is performed for heme and CSF. Three to five milliliters of nonionic radio-opaque contrast media is injected and noted to flow over the lateral borders of the ipsilateral cervical vertebral bodies. This is followed by an injection of 10cc of Marcaine 0.25% in aliquots of 2 cc with negative aspirations between injections.

The patient tolerated the procedure well without any evidence of complications or problems. They were experiencing evidence of a Horner’s sign after the block was established. They were experiencing relief from their pain after the block had set.

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