Sympathetic Dystrophies: I.V. Regional Guanethidine versus Stellate Ganglion Blocks

Abstract

The established method of temporarily blocking the sympathetic nerve supply to the upper extremity is injection of the stellate ganglion with local anaesthetic solution. Though disliked by the average patient, because it involves penetration of the neck, the stellate ganglion block has the advantage of being quickly performed by the expert. The principal disadvantage arises from the associated sympathetic block which occurs in the face. In fact unwanted facial effects are normally used as an indication of successful stellate ganglion block. It is possible to minimise the facial sympathetic blockade by attention to technique with the patient sitting upright to encourage the local anaesthetic to flow to lower levels of the cervical chain but the outcome is unpredictable. More serious is the occasional pneumothorax which occurs, though this is usually the result of poor technique or the use of the less popular posterior paravertebral approach to the region of the stellate ganglion. A frequent nuisance is the hoarse voice caused by anaesthesia of the recurrent laryngeal nerve.