You will lie face up on our treatment table with your right shoulder and neck exposed. An intravenous catheter (IV) will be inserted and a saline solution will be started. The skin on your right shoulder and neck will be cleansed with an antiseptic surgical skin preparation and sterile ultrasound gel applied to the neck. The right side of your neck will then be scanned with ultrasound and the collection of nerves identified. Once the nerves have been identified, medication for sedation will be administered as indicated (most patients will require some level of sedation), and a small amount of local anesthetic will be injected in the skin to make the procedure more comfortable. Using real-time ultrasound guidance, the needle will be guided to the stellate ganglion. Once the needle is at the target, a long-acting anesthetic will be slowly injected over 2-3 minutes. During the injection, Dr. Garwin will ask if you are doing ok, if you are having a metallic taste in your mouth, or if there is ringing in your ears. It will be safe to answer questions, otherwise you should refrain from talking or moving during the procedure.
Once the needle is removed you will continue to lie flat for 5 minutes, then you will sit up and have your SGB assessed. When an SGB is performed and the sympathetic nerves are blocked, we are looking for a temporary condition referred to as a “Horner’s syndrome”- your right eyelid will be droopy, your right pupil will be smaller than the other pupil, and the white part of your right eye may get red. This is a normal part of the block and will wear off in 4 to 8 hours. After the procedure is completed, you will be observed in the clinic for another 30-45 minutes before being allowed to go home.