Stellate Ganglion Block

A stellate ganglion block is mainly used for complex regional pain syndrome (CRPS) of the arm or hand and other pain driven by overactive sympathetic nerves, and sometimes for poor circulation in the arm^[1]. It temporarily numbs a cluster of nerves at the base of the neck. It is used alongside physical and occupational therapy, to lower pain enough for you to progress in rehabilitation^[6].

It is given at the front of the neck, a little above the collarbone and beside the windpipe, on the same side as your painful arm. The needle is guided to the front of the spine near the sixth or seventh neck vertebra, where the stellate ganglion lies^[12]. Your physician watches on ultrasound, sometimes with X-ray, to steer clear of blood vessels, the thyroid and the lung^[1].

Most people describe brief stinging from the skin numbing and some pressure in the neck rather than sharp pain. Within minutes you may notice warmth in your arm, a droopy eyelid, a stuffy nose or a lump-in-the-throat feeling — normal signs that the block is working^[7]. Light sedation can be used for anxiety, but many people stay fully awake so they can report how their arm feels.

The numbing effect and arm warmth usually start within minutes. In a very small study of people with CRPS, relief began within 30 minutes, and relief after local anesthetic sympathetic blocks averaged more than three days, compared with 19 hours after a saltwater injection^[4]. Responses vary widely, so we judge the result over several days alongside therapy.

Many people with CRPS have a short series. New York workers’ compensation guidelines note that benefit is nearly always seen within one to three blocks, with more only if function keeps improving^[6]. Medicare in New York requires documented lasting improvement if more than five blocks are needed in a lifetime^[7]. If the first well-performed blocks do not help, more of the same is unlikely to.

You should not have SGB if you have an infection at the injection site or an allergy to local anesthetics, and uncontrolled bleeding problems are a reason to wait^[7]. Extra care is needed if you take blood thinners, have significant heart or lung disease, or are pregnant. SGB is also the wrong treatment for arm pain from a pinched neck nerve. We review all of this at your consultation.

Serious complications are uncommon, but SGB is done in a sensitive area of the neck, so it is performed with image guidance and monitoring. A systematic review of reported complications found most occurred during or shortly after the block; rare serious events included a neck hematoma that blocked the airway and a deep infection^[5]. Temporary hoarseness, swallowing difficulty and Horner’s syndrome are common and expected^[7].

Take it easy for the rest of the day. Wait to eat or drink until swallowing feels normal, then start with sips of water, and do not drive if you had sedation. The droopy eyelid and hoarseness usually fade within hours. Go to your scheduled therapy, keep a pain diary, and call us for fever, increasing neck swelling, trouble breathing or new weakness.

SGB has been studied for PTSD, but it is an off-label, experimental use with mixed evidence. One randomized trial found no benefit over a sham injection^[10], while a larger trial found greater symptom improvement over eight weeks^[11], and the VA/DoD guideline found insufficient evidence to recommend for or against it^[12]. This page covers SGB for pain; please discuss PTSD care with your mental health clinician.

Coverage depends on the reason for the block. Medicare’s local policy for New York, effective October 25, 2026, covers SGB for CRPS when strict diagnostic criteria are met, other treatments have failed and you are in an interdisciplinary program; other uses are considered investigational^[7]. New York workers’ compensation recommends sympathetic blocks for acute CRPS or flare-ups^[6]. Commercial plans often require prior authorization, and no-fault claims follow their own rules. We verify your benefits before scheduling.

Possibly. SGB is classed as an intermediate bleeding-risk procedure, and the guidelines suggest considering a pause in aspirin or anti-inflammatory medicines in some cases because bleeding in the neck can be serious^[8]. The plan depends on which medicine you take and why you take it. Never stop a blood thinner on your own — we will coordinate with the doctor who prescribed it.

CRPS care is built on rehabilitation, so therapy, medicines and psychological support continue either way^[4]. If blocks do not help, or help only briefly, your physician may discuss spinal cord stimulation, which CRPS guidelines consider for patients who are not progressing^[4], or Scrambler therapy. For nerve pain limited to one nerve, peripheral nerve stimulation may be an option.