stellate ganglion tips

[gator2886]

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any tips would be appreciated: oblique approach vs ap. Retraction of vessels etc

 

[paindoc007]

any tips would be appreciated: oblique approach vs ap. Retraction of vessels etc

Furman tecnique. Ipsilatsral oblique. c6 VB. Aim ant to uncinate line. Always test dose using lido w epi.

 

[Orin]

Y'all aren't using ultrasound on these?

 

[lobelsteve]

Y'all aren't using ultrasound on these?

I don’t but I think US is superior to fluoroscopy for this. I rarely see a patient that could benefit but when I do I send them to my local pain doc friends who do these.

 

[deleted131481]

Great video for ultrasound approach - music even better.

Ultrasound-guided stellate ganglion block: safety and efficacy - PubMed

Cervical sympathetic and stellate ganglion blocks (SGB) provide a valuable diagnostic and therapeutic benefit to sympathetically maintained pain syndromes in the head, neck, and upper extremity. With the ongoing efforts to improve the safety of the procedure, the techniques for SGB have evolved...

pubmed.ncbi.nlm.nih.gov

Article with pictures.

I have one patient I do this about every three to four months - I tend to review the video above quickly each time.

 

[oreosandsake]

Fluoro 2 main standardized approaches
Nilesh patel foraminal view should be safer..

one of the procedures where US clearly better than fluoro. For all those that say I’ve done 99999953 of these with fluoro and nothing went wrong. You really have no idea what you are stabbing through. And the volume of medicine used needed to get good spread with fluoro is higher

 

[callmeanesthesia]

Maybe it’s overkill but I do combined US/fluoro. Mark C6 and skin entry on fluoro, US to guide needle past vessels and into longus coli, and then contrast on fluoro to make sure there’s good caudad spread and no vascular uptake.

 

[oreosandsake]

Maybe it’s overkill but I do combined US/fluoro. Mark C6 and skin entry on fluoro, US to guide needle past vessels and into longus coli, and then contrast on fluoro to make sure there’s good caudad spread and no vascular uptake.

not overkill. prob safest. ideal, you get both of both worlds. combo is great for procedure where you lose the needle tip past bone. ex thoracic TFESI become very simple with US/fluoro combo.

re stelate, you can figure out where c6 is on US too. c7 doesn't have an anterior tubercle.

the goal is to put the needle superficial to the LC and have it run down the pre vertebral fascia. vascular you should actually pick up even better with US as you see the vessels on the way in. interestingly, ive found my needle tip more medial than what i would have done with fluoro only. have you noticed the same thing?

 

[Baron Samedi]

Oblique view more comfortable for patient and better soft tissue hold than AP in my experience. Especially if you're doing them for PTSD, the comfort aspect is critical.

 

[DOctorJay]

Maybe it’s overkill but I do combined US/fluoro. Mark C6 and skin entry on fluoro, US to guide needle past vessels and into longus coli, and then contrast on fluoro to make sure there’s good caudad spread and no vascular uptake.

this is exactly what I do as well

 

[callmeanesthesia]

not overkill. prob safest. ideal, you get both of both worlds. combo is great for procedure where you lose the needle tip past bone. ex thoracic TFESI become very simple with US/fluoro combo.

re stelate, you can figure out where c6 is on US too. c7 doesn't have an anterior tubercle.

the goal is to put the needle superficial to the LC and have it run down the pre vertebral fascia. vascular you should actually pick up even better with US as you see the vessels on the way in. interestingly, ive found my needle tip more medial than what i would have done with fluoro only. have you noticed the same thing?

Yes, I think you’re right on it being more medial. thanks for the tip on the tubercles - I’ll watch for that next time I do one. Overall I’ve found myself doing sympathetic blocks as infrequently as possible.