Silver Spring Medical Center, LLC

Selective Ganglion Blocks

Fluoroscopy- and ultrasound-guided sympathetic ganglion blocks for complex pain syndromes, autonomic conditions, and visceral pain — targeting Stellate, Celiac, Lumbar Sympathetic, Hypogastric, and Impar ganglia.

Interrupting the Sympathetic Pain Circuit

The sympathetic nervous system plays a significant role in maintaining and amplifying certain types of chronic pain — particularly sympathetically maintained pain (such as CRPS), visceral pain syndromes, and vascular pain conditions. Selective ganglion blocks target specific sympathetic ganglia along the paravertebral chain, temporarily or durably interrupting abnormal pain signaling and autonomic dysregulation.

Dr. Grossman performs all sympathetic ganglion blocks under real-time fluoroscopic or ultrasound guidance, with contrast confirmation and continuous imaging to ensure safe, accurate needle placement adjacent to the target ganglion without injury to surrounding vascular or neural structures.

Stellate Ganglion Block

  • Target: cervicothoracic sympathetic chain (C7–T1)
  • Indications: CRPS of the upper extremity, hyperhidrosis, vasospastic conditions, hot flashes, PTSD (emerging evidence)
  • Approach: anterior paratracheal under fluoroscopy or ultrasound guidance

Celiac Plexus Block

  • Target: celiac plexus at L1 vertebral body level
  • Indications: chronic pancreatitis pain, upper abdominal visceral pain, pancreatic cancer pain
  • Approach: bilateral retrocrural or anterocrural, fluoroscopy-guided with contrast confirmation

Lumbar Sympathetic Block

  • Target: lumbar sympathetic chain (L2–L4)
  • Indications: CRPS of the lower extremity, peripheral vascular disease pain, postherpetic neuralgia
  • Approach: paravertebral under fluoroscopic guidance

Superior Hypogastric & Ganglion Impar

  • Hypogastric: Pelvic visceral pain, endometriosis-related pain, bladder and bowel pain syndromes
  • Ganglion Impar: Perineal, coccygeal, and rectal pain; coccydynia; pelvic floor pain — accessed via trans-sacrococcygeal approach under fluoroscopy

Guidance & Safety Protocol

Every sympathetic ganglion block at SSMC is performed with fluoroscopic or ultrasound imaging from initial needle placement through final injectate delivery. Contrast medium is used to confirm position and spread pattern before medication is delivered — ensuring proximity to the target ganglion while avoiding inadvertent intravascular or neuraxial injection.

  • Fluoroscopy: AP, lateral, and oblique confirmation of needle tip position
  • Ultrasound: real-time visualization for stellate and celiac approaches
  • Radiofrequency neurolysis available for prolonged effect
  • Chemical neurolysis (phenol or alcohol) available for palliative indications