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Complications associated with stellate ganglion nerve block: a systematic review
  1. Vasudha Goel1,
  2. Amol M Patwardhan1,
  3. Mohab Ibrahim1,
  4. Carol L Howe2,
  5. David M Schultz3 and
  6. Hariharan Shankar4
  1. 1 Department of Anesthesia and Pain Medicine, University of Arizona, Tucson, Arizona, USA
  2. 2 Health Sciences Library, University of Arizona, Tucson, Arizona, USA
  3. 3 Medical Advanced Pain Specialists, Minneapolis, Minnesota, USA
  4. 4 Anesthesiology, Clement Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr Vasudha Goel, Department of Anesthesia and Pain Medicine, University of Arizona, Tucson, AZ 85724, USA; doc.vasudha{at}


Stellate ganglion nerve blockade (SGNB) is a vital tool in our armamentarium for the treatment of various chronic pain syndromes. SGNB can be performed using the traditional landmark-based approach, or with image guidance using either fluoroscopy or ultrasound. In this review, we systematically analyzed reported SGNB-related complications between 1990 and 2018. Seven databases were queried for SGNB between January 1, 1990 and November 27, 2018. Search results of the complications associated with SGNB were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Out of a total of 1909 articles, 67 articles met our inclusion criteria, yielding 260 cases with adverse events. In 134 of the 260 (51.5%) cases, SGNB was performed with image guidance. Sixty-four (24.6%) and 70 (26.9%) of the complication cases reported the use of ultrasound and fluoroscopy guidance, respectively. One hundred and seventy-eight (68.4%) patients had medication-related or systemic side effects, and 82 (31.5%) had procedure-related or local side effects. There was one report of death due to massive hematoma leading to airway obstruction. There was one case report of quadriplegia secondary to pyogenic cervical epidural abscess and discitis following an SGNB. Complications following SGNB have been reported with both landmark-based techniques and with imaging guidance using fluoroscopy or ultrasound. In our systematic review, most adverse events that were reported occurred during or shortly after SGNB. Vigilance, American Society of Anesthesiologists standard monitors for conscious sedation, and accessibility to resuscitation equipment are vital to the safe performance of SGNB.

  • complications
  • pain measurement
  • sympathetic blocks
  • stellate ganglion

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  • Contributors Only those who made important contributions to the study and are thoroughly familiar with the primary data are included as authors, and all authors are responsible for the content and have read and approved the manuscript for submission to Regional Anesthesia & Pain Medicine.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was reviewed by the institutional review board and was exempt given its retrospective data analysis nature.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary material.

  • Author note The manuscript submitted is original, with no portion under simultaneous consideration for publication elsewhere, and has not been previously published.