Based on the patient's history and physical examination I believe that it is medically indicated for the patient to undergo a left stellate ganglion sympathetic block. Due to the need for anatomical precision, diagnostic/therapeutic accuracy,and safety fluoroscopy is indicated.
Informed consent was obtained. Utilizing an anatomic model the needle entry point, spinal cord, nerves, and blood vessels were pointed out to the patient and the procedure was explained. Benefits versus risks such as but not limited to infection, hemorrhage, seizure, nerve damage, etc. were discussed with the patient. All questions were answered. The patient is aware of alternative therapies.
After prep with alcohol and lidocaine 1% injected for skin anesthesia via a 27 gauge 1/2 inch needle a 22 gauge Jelco IV catheter was inserted into a left hand dorsal vein.
A time out was performed to confirm proper patient, procedure, and side. The patient was placed in the supine position on a radiolucent table with the neck extended and turned to the side opposite the block. The patient was imaged with fluoroscopy and the skin entry point was marked. The patient was prepped with chlorhexidine and then alcohol solutions, Sterile drapes were applied.
Lidocaine 1% was infiltrated for skin anesthesia using a 27 gauge 1 1/2 inch needle. Under fluoroscopic guidance a 25 gauge 2 inch Quincke needle was advanced to the junction of the uncinate process and the C6 vertebral body as demonstrated in an ipsilateral oblique view. Needle position was confirmed in the AP view. After negative aspiration Omnipaque 240 0.5 ml was injected under live fluoroscopy and no vascular uptake was present. An additional 1.5 ml of Omnipaque was injected to visualize the longus colli muscle. Lidocaine 2% 0.5 ml was injected and the patient was observed. An additional 9.5 ml was injected slowly.
The patient developed Horner’s syndrome, Guttman’s sign, increased temperature on the ipsilateral side of the block, and relief of left upper extremity pain. The patient tolerated the procedure well, had no complications, and was discharged in satisfactory condition after a period of observation.