Stellate Ganglion Injection: Ultrasound Guidance

For ultrasound (US), a transverse in plane with long-axis confirmation technique at the level of the Chassaignac’s tubercle of C6 is described. By utilizing a hybrid fluoroscopic approach, US is used to carefully position the needle away from critical structures in the soft tissue of the anterolateral neck, guiding the safest injection possible. After US-guided (USG) needle placement, injected contrast under fluoroscopy (hybrid technique) verifies unilateral and nonvascular contrast flow. Vital structures identified and avoided under USG injection include the trachea, esophagus, thyroid, inferior thyroid artery, recurrent laryngeal nerve, common carotid artery, internal jugular vein, and vertebral artery.