Cervical Sympathetic Block: Fluoroscopy

In those patients with significant sympathetically maintained pain, repeated blocks may provide a therapeutic value and help facilitate physical therapy and rehabilitation. Cervical sympathetic blocks have been traditionally performed by using surface landmarks, however imaging-guided blocks are strongly recommended to avoid potential serious complications. Most preganglionic sympathetic efferents innervating the head, neck, and upper extremity either pass through or synapse at the stellate ganglion. This provides an ideal target for blockade of sympathetic innervation to the head, neck, and upper limbs. The stellate ganglion block can be performed at the C6 and C7 transverse processes. Fluoroscopy is a reliable method for identifying bony surfaces, which facilitates identifying the C6 and C7 transverse processes; however, this is only a surrogate marker, because the location of the cervical sympathetic trunk is defined by the fascial plane of the prevertebral fascia, which cannot be visualized with fluoroscopy.