Stellate ganglion block in contemporary anesthesia practice: perioperative applications, emerging indications, and risk management

Stellate ganglion block (SGB), an interventional technique that modulates sympathetic activity, has been increasingly investigated beyond traditional pain management in cardiology, neuropsychiatry, and perioperative medicine. This narrative review examines the evolving role of SGB in contemporary anesthesia practice, emphasizing that its effects may extend beyond immediate peripheral sympatholysis to longer-lasting central neural modulation. Technically, ultrasound guidance facilitates precise needle placement and low-volume injection, with improved visualization of relevant anatomy and injectate spread. Dose-finding studies have refined local-anesthetic volume and concentration, whereas continuous blockade may extend sympatholysis in selected refractory conditions. Clinically, SGB has been used in selected pain conditions, including complex regional pain syndrome and herpes zoster–related pain, and has been investigated for non-pain indications such as post-traumatic stress disorder, refractory ventricular arrhythmias, and menopausal vasomotor symptoms. In perioperative settings, SGB has been evaluated for postoperative analgesia, modulation of inflammatory responses, and potential neuroprotective effects. Risk mitigation relies on real-time ultrasound visualization of the needle tip, adjacent vascular structures, and injectate spread, together with predefined management protocols for major complications. Future research should prioritize multicenter prospective studies, standardized procedural parameters, and individualized treatment pathways to support the safe, precise, and evidence-based use of SGB across clinical settings.