Download Stellate Ganglion Block For Non Acute Pain

Stellate Ganglion Block
For Non Acute Pain
Patient information Leaflet
February 2017
Please read this leaflet carefully.
If you do not follow these instructions your procedure
may be cancelled.
TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
What is a Stellate Ganglion Block?
There is a group of nerves called sympathetic nerves, which control things we do not
need to think about such as blood pressure and heart rate. The stellate ganglion
contains a bundle of sympathetic nerves for the head, face, neck, arm and heart and
can be found on either side of the voice box, at the base of the neck. Unfortunately
pain messages from the head, face, neck , arm and the heart are sent along these
nerves to the brain where the pain is interpreted.
A stellate ganglion block involves an injection of local anaesthetics and steroid
medication around this bundle of nerves. This blocks the pain messages thereby
reducing the pain. The block is usually temporary but the benefit can sometimes be
prolonged.
What Are The Benefits?
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Temporary relief of pain, however the longer the symptoms have been
present, the less successful the outcome.
Improved mobility
Aid in diagnosis
What are the possible side effects/complications of the procedure?
All procedures in medicine carry a risk of complications. Precautions are always
taken to minimize the risk as far as possible. Generally injections are safe but
occasionally the following risks may occur:
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Failure of the procedure to reduce pain
Droopy eyelid
Worsening of pain (temporarily or permanently)
Bleeding/bruising in the injection area
Infection
Hoarseness / sore throat / difficulty swallowing
Allergic reactions
Numbness (temporary or permanently)
Stuffy nose
Collapsed lung
Collapse
Potential side effects with using steroids
There are few side effects associated with either single or occasional use of steroids.
These include hot flushes, feeling sick, mild abdominal pain, fluid retention, raised
blood sugar in diabetics and occasionally menstrual irregularities. These symptoms
should settle in a few days.
• If you take water tablets (Diuretics) on a regular basis then please take an
extra water tablet the day after your procedure.
• If you are diabetic you should closely observe your diabetic control for the next
fortnight.
Stellate Ganglion Block for Non Acute Pain Patient Information Leaflet
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TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
Repeated and frequent use of steroids has the potential to lead to more serious
effects but the doses of steroids given in the injections are small when compared with
the doses of steroids taken by mouth on a regular basis.
Are there any alternatives?
A stellate ganglion block is rarely a first line treatment and you may consider trying
other approaches such as simple painkillers, exercise, physio, Transcutaneous
Nerve Stimulation or acupuncture first (TENS). If you would like to discuss other
alternatives please contact the nurse on the number provided within this leaflet.
Prior to admission
You must inform the Non Acute Pain Team at least 1 week prior to your
procedure:
1.
If you are allergic to local anaesthetic or steroid medication.
2.
If you are or think you may be pregnant.
3.
If you have an infection near the site of the injection or elsewhere.
4.
If you are taking antibiotics or drugs used to treat other infections eg
Tamiflu or have finished a course within the three weeks prior to your
procedure date.
5.
If you are taking blood thinning drugs such as: Warfarin, Sinthrome,
Aspirin, Clopidogrel, Ticlopidinem, as it will be necessary to stop taking
these medications prior to your procedure. You should consult the doctor
who prescribed them to see if you can stop them temporarily to have this
procedure.
6.
If you are experiencing any difficulty or frequency in passing urine.
7.
If you have had a vaccination (including the Flu Vaccine) or are planning to
have a vaccination within one month of your appointment.
8.
If you have had a heart attack within the last twelve months.
9.
If you have undergone surgery or had an illness within the last four weeks.
10.
If you do not have anyone to collect you and stay with you for 24 hours
following discharge on the day of your procedure.
Please note:
If you are diabetic, please ensure that your HBA1C level has been checked within
three months of your procedure date and you obtain a copy of the result, as the
Pain Nurse will ask for this reading prior to confirming your procedure appointment.
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TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
Please do not drive yourself to the hospital as you will not be able to drive home
following your procedure. You must arrange for a responsible adult to collect you
and take you home by car or taxi, and they must be able to stay with you overnight. If
this is not possible your procedure may have to be postponed.
How long will I be in hospital for?
The procedure is performed as a day-case the time detailed on your appointment
letter relates to your admission time your procedure will be carried out later that
morning/afternoon. Please be prepared to stay approximately half a day, although
you should bring your dressing gown, slippers and current medication with you in the
event that you are required to stay in hospital overnight.
On the day of your procedure
Before Admission
Please follow the starving instructions below:
The day before your procedure:
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You should eat normally, but avoid large fatty meals
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No alcohol for 24 hours before your procedure
Fasting on the day of your procedure:
Morning Procedure
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NO food after 2.30am, no chewing gum or boiled sweets after 2.30am
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NO smoking on the day of your admission
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You may have clear fluids (water, weak juice, black tea/coffee – NO milk or
milk products) up to 6am on the morning of your operation/procedure.
Nothing by mouth after 6.30am on the day of procedure.
Afternoon Procedure
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You may have a light breakfast (such as toast or continental breakfast, or a
small bowl of cereal). NO food after 7.30am.
• You may have clear fluids (water, weak juice, black tea/coffee – NO milk or
milk products) up to 11.30am.
Nothing by mouth after 11.30am on the day of procedure.
Stellate Ganglion Block for Non Acute Pain Patient Information Leaflet
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TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
Evening Procedure
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You may a eat light breakfast and light lunch up to 12.00 noon. NO food
after 12.00 noon.
You may have clear fluids (water, weak juice, black tea/coffee – NO milk or
milk products) up to 3.00pm.
Nothing by mouth after 3.00pm on the day of procedure.
If you are unwell on the day of your procedure please contact:
The Non Acute Pain Secretary on 0161-922-6816
OR
The Daycase Unit on: 0161-922-6219
What will happen to me before the procedure?
On arrival to the unit, you will be asked to complete a pre-admission questionnaire,
before being admitted by a nurse. During your admission the nurse will discuss the
information provided in the questionnaire and record your pulse, blood pressure,
respiratory rate, temperature and oxygen saturation (amount of oxygen in your
blood), you may also be asked to provide a urine sample. If the information provided
highlights a cause for concern or your observations are abnormal your procedure
may be cancelled pending further investigation and treatment.
Following admission you will be asked to return to the waiting area until your
procedure time. Once you are called, the doctor will explain the procedure to you,
and give you the opportunity to ask any questions. If you agree to have the
procedure you will be asked to sign a consent form and and may be required to put
on a gown.
What will happen to me during the procedure?
You will be asked to lie in a comfortable position on your back with a small support
under your shoulders. A small needle may be inserted into the back of your hand, the
doctor will then place a small needle in the front of your neck and inject some local
anaesthetic solution and possibly some steroid medicine. An Xray machine may be
used to help guide the doctor. You may feel some pressure as the medicine is being
injected.
What will happen to me after the procedure?
You will be required to stay on the unit for around 30 minutes, during this time your
observations will be recorded regularly. You may notice that your eyelid is droopy,
your voice has become hoarse, or your throat is sore. You may also experience
numbness/weakness in your arm, these symptoms are to be expected and should
settle within a couple of hours.. You should therefore seek assistance from the
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TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
nursing staff before having refreshments and you must not drink anything hot
immediately after your procedure. Where symptoms persist it may be necessary for
you to stay in hospital overnight for observation.
You may have a dressing to the injection site, this can be removed after 24 hours.
Please ensure you follow the instructions you are given about rest, exercise and how
long to stay off work.
Discharge Arrangements
It is important that someone comes to collect you, and you do not attempt to drive
yourself home. If you do not have anyone to escort you home, then you must
discuss this with the pain team before the day of your procedure or your procedure
will be cancelled.
Once at Home
On the day of the procedure make sure that you rest for the rest of the day. It is
important that you monitor the effect of the injection on your pain, level of movement
and appearance of your arm/leg over the next couple of weeks as this will assist
doctors in planning further treatment. It is important that you try to increase your
exercises moderately if the effects of your injection appear to have been helpful.
If you have been given sedation it is important that in the following twenty four
hours:
• You Do Not drive as your insurance will not cover you.
• You Do Not operate machinery (including cooking and using other domestic
appliances).
• You Do Not drink alcohol.
• You Do Not make important decisions.
• You are Not left alone in the house to look after small children.
Following your procedure an out patients’ appointment will be arranged in order for
you to evaluate the effectiveness of treatment and discuss further management with
the Non Acute Pain Team.
If There Is A Problem
If you have any concerns about anything relating to the appointment date or time
please contact the Non Acute Pain Secretary.
If you have any concerns relating to your procedure please contact the pain nurse.
Contact Numbers:
The Non Acute Pain Secretary can be contacted:
Mon-Fri 9am-5pm on 0161-922-6816
The Non Acute Pain Nurse can be contacted on:
Monday-Friday on 0161-922-6986 / 6759
Stellate Ganglion Block for Non Acute Pain Patient Information Leaflet
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TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
N.B. Outside these hours leave a message and the secretary or the nurse will get
back to you. However if the matter is urgent please contact your GP, NHS 111 or
attend your local accident and emergency department.
Other Useful Contacts or Information
NHS 111
The Trusts Patient Information Centre 0161 922 5332
British Pain Society 020 7269 7840 / www.britishpainsociety.org/home
Source of Good Practice
W.B. Saunders (1999), “Atlas of Regional Anaesthesia”, 2nd Ed., Philadelphia, USA
ABPI, “Compendium of Data sheets and summaries of product characteristics”,19992000.
If you have any questions you want to ask, you can use this space below to remind
you.
If you have a visual impairment this leaflet can be made
available in bigger print or on audiotape. If you require either of
these options please contact the Patient Information Centre on
0161 331 5332
Stellate Ganglion Block for Non Acute Pain Patient Information Leaflet
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TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST
Document control information
Author:
Jayne Grant, Clinical Nurse Specialist Pain Service
Dr B. Ousta, Consultant Anaesthetist, Non Acute Pain
Dr M. Ramay, Consultant naesthetist, Non Acute Pain
Sr Kirstine McClure, Non Acute Pain Service
Division/Department: Anaesthetic Department
Date Created:
Date Reviewed
Reference Number:
July 2013
February 2017
NAP 013
Version:
2.2
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