• - Pain due to invasion by neoplasm with short life expectancy (Pancoast, …)
• - Complex regional pain syndrome (Causalgia)

Target: Stellate ganglion at the anterior aspect od the C7 transverse process.

Procedure:

• - Patient in supine position with i.v. drip
• - Opposite side head rotation
• - Axial scan from C6 to Th2 after i.v. constrast injection
• - Delination of the transverse process of C7 and the anterior lying vertebral artery
• - CT fluoroscopy-guided trans-scalenic puncture from skin to anterior aspect of C7 transverse process with a 22 or 25 gauge needle.
• - Infiltration of 1 mL of lignocaine (Block infiltration) mixed with contrast media (25/75%)
• - If pain regresses significantly, neurolysis is performed with 1.5 mL of pure ethanol : pain regresses immediately and a Horner Syndrome appears instantly.

Danger:

• - Phrenic nerve damage (anterior aspect of anterior scalen muscle)
• - C5 and C6 brachial plexus branches damage (posterior aspect of anterior scalene muscle)
• - Vertebral artery puncture
• - C7 and C8 motor neuron lysis due to diffusion
• - Subdural and epidural space diffusion.