Is anyone going to try the Stellate Ganglion Block procedure?

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Read Cort's post at HR about a clinic in Alaska having good results treating the symptoms of two Long Covid patients with a Stellate Ganglion Block procedure. And looking through the PR forums, it doesn't seem like many people have tried it, and even then just with an expectation that it might alleviate pain.

It's a tiny sample size, and I have no idea how reputable the clinic is (although they get good reviews on Google). But given that it seems like a fairly straightforward procedure with few complications or side effects, I was curious if anyone here was planning on experimenting with it.
 
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Read Cort's post at HR about a clinic in Alaska having good results treating the symptoms of two Long Covid patients with a Stellate Ganglion Block procedure. And looking through the PR forums, it doesn't seem like many people have tried it, and even then just with an expectation that it might alleviate pain.

It's a tiny sample size, and I have no idea how reputable the clinic is (although they get good reviews on Goodle). But given that it seems like a fairly straightforward procedure with few complications or side effects, I was curious if anyone here was planning on experimenting with it.
We have a woman in the discord who went, but she never came back so either she died or got healthy 😅

Now we got a few people interested in it, let's hope they have success 🙌🏼
 

Sushi

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Jyoti

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I have been crossing paths with this procedure regularly over the last few weeks....almost like it is following me and calling: try me, try me! I am curious and attempting to find out as much as I can before a meeting with a pain doctor later in the month. I had scheduled that for another issue, but will seize the moment, if I can, to ask questions and feel him out.

A good friend of mine is an avid and excellent researcher and got pretty excited about this prospect. He dug up a few interesting bits in the last day or so that I wanted to share. Might not be of interest to any but those who are seriously contemplating this intervention.

From:
Neuroanatomy, Stellate Ganglion
Mayank Mehrotra; Vamsi Reddy; Paramvir Singh.
https://www.ncbi.nlm.nih.gov/books/NBK539807

/
Approaches to a stellate ganglion block[5][6]:

Multiple approaches have been used to block the stellate ganglion and include the use of ultrasound, MRI, and/or plain fluoroscopic guidance.

  • Surface landmark technique - (using the C6 anterior approach)
The patient is in the supine position with the head in a slight extension. The head is turned towards the opposite side, away from where the block is to be performed. The cricoid cartilage is palpated to ascertain the C6 level. At the C6 level, we palpate for the C6 transverse process, which is also known as the Chassaignac tubercle. In most individuals, the tubercle is 3 to 4 cm cephalad to the sternoclavicular joint at the medial border of the sternocleidomastoid. The needle is advanced in the anteroposterior direction until it hits the tubercle. The needle is withdrawn about 2mm to come out of the longus colli muscle. A test dose of about 1 mL is administered after negative suction, then subsequently administer 8 to 10 mL of local anesthetic administration.

  • Fluoroscopy-guided technique
This technique offers the advantages of providing better bony delineation. It also involves the administration of contrast, which assures that the needle tip is in the appropriate fascial plane. If a striated appearance shows on the administration of the contrast media, it means that the needle tip is probably intramuscular. Immediate dissipation of the dye indicates that the needle tip is intravascular in position.

  • Ultrasound-guided C6 transverse approach
The carotid sheath and the sternocleidomastoid muscles are retracted laterally with the help of the ultrasound transducer. Gentle pressure is applied to reduce the distance between the skin and the tubercle. Needle insertion is towards the Chassaignac tubercle. After contacting the tubercle, the needle is withdrawn about 1 to 2 mm to bring it in the area of the prevertebral fascia. After negative aspiration, the local anesthetic (approximately 2 mL) is injected, and the spread is carefully visualized with the use of the ultrasound. Once the visualization confirms subfascial drug deposition, the clinician can administer the remainder of the local anesthetic.

  • Ultrasound-guided C7 anterior approach
This method carries a slightly higher risk of pneumothorax and vertebral artery injury. However, it provides a much more consistent blockade as the needle lies closer to the ganglion. A smaller volume of local anesthetic can bring about a more consistent block with this technique. It is particularly useful in cases of failed blocks at the C6 level. The C7 approach always needs imaging as the C7 vertebrae have a vestigial tubercle which is not readily palpable.
Also, given that some steroid is often used in the injection, I thought I would try icing the general vicinity on both sides during a crash I had today and while we all know that it could be a one-off, the crash lifted slowly, gently and pretty thoroughly after 30 minutes of icing.


1640992978556.png


And if you are still reading and interested is seeing how it is done under ultrasound, this is a refreshingly wryly narrated video:
 
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