Thoracic Sympathetic Blocks


The sympathetic nervous system is associated with many pain conditions. Blocking sympathetic ganglia with local anesthetics can be used in the treatment of sympathetically mediated pain. A thoracic sympathetic block is used to treat painful conditions such as complex regional pain syndrome, postherpetic neuralgia, phantom breast pain, and peripheral vascular disease of the upper extremities.

A thoracic sympathetic block is performed via a percutaneous approach using fluoroscopic or computed tomographic guidance. The procedure is a safe, non-surgical treatment for those experiencing chronic pain, during which a needle is placed through the skin and local anesthetic is injected to alleviate pain. The block is performed in an outpatient setting and is considered minimally invasive because it requires no incisions. As opposed to a stellate ganglion block, a thoracic sympathetic block may be performed for the following reasons:

  • 20% of patients have sympathetic fibers that bypass the stellate ganglion and may not reliably achieve sympathetic blockade with a stellate ganglion block
  • Neurolytic techniques of the stellate ganglion have a risk of prolonged Horner syndrome
  • The thoracic sympathetic block avoids some potential complications associated with a stellate ganglion block
  • The thoracic sympathetic block is indicated for the same conditions as a stellate ganglion block


A thoracic sympathetic block is commonly used to treat conditions such as:

  • Complex regional pain syndrome type I and II
  • Herpes zoster (i.e. shingles)
  • Postherpetic neuralgia
  • Postradiation arteritis
  • Neuropathic pain associated with a central nervous system pathology
  • Paget disease
  • Phantom limb pain
  • Angina pectoris