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

The red star above denotes the intended target for lidocaine injection

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

See Also

Pulseless arrest

Double simultaneous external defibrillation

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.