Stellate Ganglion Injections

A stellate ganglion block, guided by imaging, quiets certain nerve-driven pain in the arm, hand, head, and neck. It helps CRPS, phantom limb pain, and shingles nerve pain, at Remix Medical in Houston, TX.

Book a consultation (713) 597-5131

By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jul 9, 20262 min read

Key takeaways

A stellate ganglion block places local anesthetic onto the cervicothoracic sympathetic ganglion at C6–C7 under ultrasound or fluoroscopic guidance, interrupting sympathetic outflow to the head, neck, and arm on that side.
It's both a diagnostic test for sympathetically maintained pain and, in responders, a therapeutic intervention — main indications are upper-limb CRPS, phantom limb pain, post-herpetic neuralgia, and vascular conditions like Raynaud's; use in PTSD is emerging and still investigational.
A successful block produces temporary Horner's syndrome (drooping eyelid, constricted pupil, reduced facial sweating) and a visibly warmer hand — expected signs of success, not complications; their absence suggests the block missed the ganglion.
It sits among the carotid artery, jugular and vertebral vessels, and recurrent laryngeal nerve, so it demands image guidance, and bilateral same-day blocks are avoided because bilateral vocal-cord or phrenic involvement could threaten the airway.
As with lower-limb sympathetic blocks, no single injection cures CRPS; the block's value is the analgesic window it opens for intensive physical therapy, and a positive response is typically followed by a short series.

Stellate Ganglion Block in Houston, Texas

The stellate ganglion sits at the base of the neck and governs sympathetic supply to the head, neck, and arm. Blocking it does something that surprises patients: within minutes, the hand warms, the eyelid droops slightly, and pain that has been relentless for months becomes negotiable.

What is a Stellate Ganglion Block?

A stellate ganglion block places local anesthetic onto the cervicothoracic sympathetic ganglion at the level of C6 or C7, under ultrasound or fluoroscopic guidance. It interrupts sympathetic outflow to the upper limb and the face on that side.

It serves as both a diagnostic test for sympathetically maintained pain and, in responders, a therapeutic intervention repeated in a short series.

Stage	What happens
Before	You're positioned, the skin is cleaned and numbed, and live imaging (fluoroscopy or ultrasound) guides the needle
During	The medication is placed precisely at the sympathetic nerves in your neck; most people feel pressure more than sharp pain
After	You rest briefly and go home the same day — arrange a driver if you received sedation

What It Treats

Complex Regional Pain Syndrome (CRPS) of the arm or hand
Phantom limb pain after upper-limb amputation
Post-herpetic neuralgia of the head, neck, or upper chest
Vascular insufficiency of the arm, including Raynaud's phenomenon
Refractory angina in selected patients
Hyperhidrosis of the hand
Post-traumatic stress disorder , an emerging and still-investigational application

Signs the Block Worked

A successful stellate ganglion block produces a recognizable cluster of temporary effects on the treated side, known as Horner's syndrome: a drooping eyelid, a constricted pupil, and reduced facial sweating. The hand becomes visibly warmer. These findings resolve within hours.

They are expected and reassuring, not complications. Their absence suggests the block did not reach the ganglion and that any pain relief should be interpreted cautiously.

A Careful Procedure at Remix Medical

The stellate ganglion sits among the carotid artery, jugular vein, and vertebral artery. This is not a landmark procedure.

How it's performed

The patient lies supine with the neck slightly extended. Under ultrasound or fluoroscopic guidance, the transverse process of C6 or C7 is identified and the carotid artery, jugular vein, and thyroid are visualized and avoided. A needle is advanced to the anterolateral surface of the vertebral body, aspiration excludes vascular placement, and a small test dose precedes the full injection of local anesthetic onto the ganglion. Skin temperature and pupil size are monitored as markers of successful blockade.

How to prepare

Nothing to eat or drink for 6 hours before the procedure. Arrange a driver. Hold anticoagulants only as directed by the prescribing physician. Disclose any history of vocal cord problems, severe COPD, glaucoma, or recent heart attack. Do not schedule a bilateral block.

What to expect after

Do not eat or drink until swallowing and voice are fully normal — usually 4 to 6 hours. Do not drive for the remainder of the day. Expect a droopy eyelid, small pupil, warm hand, and hoarseness on the treated side; these resolve on their own. Schedule physical therapy to fall inside the window of pain relief. Report difficulty breathing, chest pain, severe neck swelling, or a rapidly expanding neck mass immediately.

Outcome

A successful block produces immediate warming of the hand and temporary Horner's syndrome on the treated side, confirming sympathetic blockade. In sympathetically maintained pain, patients typically experience substantial short-term relief that enables intensive physical therapy — the combination that drives functional recovery.

Frequently asked

Stellate Ganglion Injections questions, answered

What is a stellate ganglion block?

It's an injection that numbs a cluster of sympathetic nerves in the neck. It's used for certain nerve-pain and circulation conditions affecting the head, neck, or arm.

What does a stellate ganglion block treat?

It's used for complex regional pain syndrome of the arm, some nerve pain, and circulation problems in the hand. It's increasingly studied for other uses too.

Is it diagnostic or therapeutic?

It can be both: the response helps confirm the sympathetic nerves are involved, and a series of blocks can provide lasting relief for the right condition.

Does the stellate ganglion block hurt?

The area is numbed and imaging guides the needle, so you'll feel pressure. A droopy eyelid, warm hand, or hoarse voice for a few hours afterward is expected and temporary.

Sources

References

Piraccini E, Munakomi S, Chang KV. Stellate Ganglion Blocks. StatPearls. NCBI Bookshelf — https://www.ncbi.nlm.nih.gov/books/NBK507798/
Cheng J, Salmasi V, You J, et al. Outcomes of Sympathetic Blocks in the Management of Complex Regional Pain Syndrome: A Retrospective Cohort Study. Anesthesiology 2019;131(4):883–893 — https://pubmed.ncbi.nlm.nih.gov/31365367/
Harden RN, Oaklander AL, Burton AW, et al. Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 4th Edition. Pain Med 2013;14(2):180–229 — https://doi.org/10.1111/pme.12033
Wie C, Gupta R, Maloney J, et al. Interventional Modalities to Treat Complex Regional Pain Syndrome. Curr Pain Headache Rep 2021;25(2):10 — https://pubmed.ncbi.nlm.nih.gov/33598799/
Elias M. Cervical sympathetic and stellate ganglion blocks. Pain Physician 2000;3(3):294–304 — https://pubmed.ncbi.nlm.nih.gov/16906187/
National Institute of Neurological Disorders and Stroke: Complex Regional Pain Syndrome — https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome

SpecialtyPain ManagementTypeProcedureBody locationStellate ganglion, cervicothoracic sympathetic ganglion, C6 and C7 transverse process, upper extremity, head and neckCPT code64510 (injection, anesthetic agent; stellate ganglion, cervical sympathetic); 76942 (ultrasound guidance, when reported separately); 77003 (fluoroscopic guidance, when reported separately)

Also called Stellate Ganglion Injection, Cervical Sympathetic Block, SGB, Cervicothoracic Ganglion Block

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026. Medically reviewed by Raju Mantena, DO.