CNS Toxicity of Stellate Ganglion Block

Clinical Context and Risk Factors

The American Society of Anesthesiologists notes that stellate ganglion blocks pose unique risks due to their proximity to major cerebral vessels, unlike peripheral nerve blocks that are not expected to exacerbate hemodynamic instability 2, 3

The American Heart Association guidelines support the administration of intravenous lipid emulsion (ILE) therapy for severe local anesthetic systemic toxicity, as it creates a lipid compartment in the serum that reduces the concentration of lipophilic medications in tissues by sequestration 1
The American Heart Association recommends administering intravenous lipid emulsion (ILE) therapy for cardiac arrest resulting from local anesthetic toxicity, as higher doses can improve outcomes 1

Severe manifestations of CNS toxicity from stellate ganglion block include confusion, agitation evolving to frank seizures, convulsions, CNS depression, respiratory depression, and/or respiratory arrest, with an incidence of severe CNS complications of approximately 1.7 per 1000 blockades 1

The American Society of Anesthesiologists states that stellate ganglion block is contraindicated or not recommended for routine long-term treatment of non-CRPS neuropathic pain, but may be used as a component of multimodal treatment for CRPS when there is consistent improvement and increasing duration of pain relief 4