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Fluoroscopy Vs. Ultrasound

Fluoroscopy Vs. Ultrasound Guidance During the SGB Procedure

A stellate ganglion block (SGB) is not a new procedure. In use since the 1950s, the procedure works by injecting a long-acting local anesthetic into the neck where the main nerve of the sympathetic nervous system is located (the stellate ganglion). Used to treat a variety of conditions from PTSD to hot flashes, the SGB procedure is becoming increasingly popular. There are three main options to aid the delivery of the drug into the stellate ganglion.

  • Blind delivery
  • Fluoroscopy
  • Ultrasound

Blind delivery is the most high-risk option as it runs the risk of damaging nerves, scraping tendons, or misdelivering the anesthetic. While guidance methods such as computerized tomography, MRIs, and radionucleotide tracers are also valid options to consider, they are generally too time-consuming and expensive for more widespread use. That means the vast majority of clinics will offer fluoroscopy and/or ultrasound SGB treatment. Both techniques have their advantages.

Using Fluoroscopy to Deliver the SGB for PTSD

Fluoroscopy guided SGB procedures have a high level of accuracy in terms of guiding the needle directly towards the intended target. There is a considerable spread of contrast possible with fluoroscopy, meaning that epidural and intrathecal injections are possible to rule out. Fluoroscopy works by initially administering a dye into the target area. This allows for clearer identification of bone structure and makes it considerably easier to visualize the spread of the anesthetic.

Fluoroscopic guidance has been shown to vastly improve the effectiveness of the SGB injection for PTSD. When compared to blind delivery, fluoroscopic guidance helps to avoid potential complications such as lesions in the lung or pleura. That more accurate needle placement is a core component of fluoroscopy and a key reason why the treatment is growing in popularity.

Stellate Ganglion Block for PTSD using Fluoroscopy

Fluoroscopic imaging has a vast number of uses, but its value for the safe delivery of the SGB for PTSD should not be underestimated. Safe and highly effective, fluoroscopy-guided delivery of the anesthetic results in fewer complications and fewer risks. That’s because it allows the doctor to see the level of the cervical spine that he is going to inject. 

A contrast medication is then injected into the target area, which can be seen through x-ray imaging. Once the contrast medication is injected, it will begin to spread and outline any blood vessels or other surrounding tissues. This helps the doctor to avoid any major structures and ensure that he is injecting into the right area. In general, fluoroscopy makes target visualization easier and safer. 

While fluoroscopic guidance still requires specialist training, patients gain a number of advantages when this option is taken over ultrasound. Not only are there fewer risks of patient harm but fluoroscopy-guided SGBs increase the chances of a successful procedure. The visualization of the contrast medication increases the success rate of the SGB procedure. While both fluoroscopy and ultrasound delivery methods are vastly superior to blind delivery, fluoroscopic guidance allows for a more low-risk procedure that has a high success rate.

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