Nerve block: stellate ganglion

Overview

• Can be considered in cases of refractory ventricular fibrillation after other interventions have failed
• Theoretical benefit of blocking sympathetic drive leading to refractory dysrhythmia

Indications

• Refractory ventricular fibrillation

Contraindications

• Overlying skin infection

Equipment Needed

• Ultrasound with high frequency linear transducer
• 2.5-5cm 22-gauge spinal needle
• 10ml of 1% lidocaine without epinephrine

Procedure

1. Place probe over left anterior neck

2. Identify thyroid gland, carotid artery, C6/C7, longus colli muscle, and prevertebral fascia

3. Advance needle to stellate ganglion which is deep to prevertebral fascia and superficial to longus colli muscle

4. Inject 1-2 ml of anesthetic and observe dissection of the muscle and fascia layers to confirm placement

5. With placement confirmed, inject the rest of the anesthetic for a total of 10ml of volume

Complications

• Accidental injection of anesthetic into vascular structure

References

1. Margus, C, Correa, A, Cheung, W, et al. Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation. Ann Emerg Med. 2020;75(2):257–260.