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Topographic Anatomy · Neck Surgery

Blockade of the carotid sinus zone and stellate ganglion

Ganglion stellatum

These types of regional anesthesia play a key role in emergency surgery and traumatology for relieving shock and severe pain syndromes. Successful execution of these procedures requires impeccable knowledge of neck landmarks and a strict sequence of needle advancement.

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Injection siteIntersection of the anterior border of the sternocleidomastoid muscle and the level of the thyroid cartilage
Leriche methodAnterior approach to the stellate ganglion (most common)
AnestheticProcaine 0.5% — 10 to 25 ml depending on the type of block
Deep targetCarotid sheath at the level of its bifurcation
3 min readFor medical studentsUpdated 09/24/2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Sinocarotid zone block

This intervention aims to target the reflexogenic zone located in the region of the common carotid artery bifurcation.

Main indications:

  • Treatment and prevention of shock states. In such cases, the procedure is performed bilaterally (bilateral block).
  • The need for targeted regulation of blood pressure, cerebral blood flow intensity, as well as correction of cardiovascular and respiratory system functions.

Topographic and anatomical landmarks and technique:

  1. Patient position: identical to the positioning for a vagosympathetic cervical block.
  2. Determining the injection site: the surgeon locates the anterior border of the sternocleidomastoid muscle (m. sternocleidomastoideus). The needle insertion point is located precisely at the intersection of this border with a horizontal line mentally drawn through the upper border of the thyroid cartilage.
  3. Drug administration: the needle is advanced deep into the tissues until reaching the carotid sheath (bifurcation level). 20–25 ml of a 0.5% procaine solution is injected on each side.

Stellate ganglion block (ganglion stellatum)

The stellate ganglion is an important sympathetic plexus. Access to it can be achieved via an anterior, lateral, or posterior approach, although the anterior Leriche approach dominates in surgical practice.

Indications for the procedure:

  • Presence of causalgic (excruciating, burning) pain resulting from gunshot or other injuries to the upper extremity.
  • Prevention of upper extremity gangrene, which may occur due to acute occlusion of major arterial trunks.

Leriche performance algorithm:

  1. Positioning: the patient lies supine. A bolster is placed under the scapulae, and the patient's head must be turned to the side opposite to the block site.
  2. Injection site: determined at the posterior border of the m. sternocleidomastoideus, 4 cm above the clavicle level.
  3. Needle trajectory:
  4. Initially, the needle is directed strictly perpendicularly to the vertebral column until a bony resistance is felt.
  5. After contacting the bone, the needle must be slightly withdrawn.
  6. Then the direction is changed: the needle is angled 30° laterally and inferiorly.
  7. In this direction, the needle is advanced deeply by a distance equal to the height of one cervical vertebra.
  8. Anesthetic administration: 10 ml of 0.5% procaine solution is injected into the reached fascial space.
Test your knowledge on this topicTasks from the "Topographic Anatomy" course bank — immediate answers and breakdowns.

Briefly: answers to topical questions

Which anatomical structures fuse to form the stellate ganglion?

The stellate ganglion is formed by the fusion of two sympathetic trunk ganglia. The following anatomical structures participate in its formation:

  • Inferior cervical ganglion (ganglion cervicale inferius)
  • First thoracic ganglion (ganglion thoracicum I)

The branches of the formed cervicothoracic ganglion subsequently extend onto the walls of the vertebral and subclavian arteries, forming the corresponding nerve plexuses.

How to memorize

For sinocarotid block, remember: ANTERIOR border of the muscle and UPPER border of the cartilage. For the stellate ganglion — POSTERIOR border of the muscle and 4 cm ABOVE the clavicle.

Class and exam questions

What is the difference in head position between these two blocks?

When performing a stellate ganglion block, the head must be turned to the opposite side, and a roll is placed under the scapulae. For the sinocarotid block, the standard position used for the vagosympathetic block is applied.

What concentration and volume of procaine are used?

In both cases, a 0.5% procaine solution is used. However, the sinocarotid zone requires 20–25 ml (on each side), while 10 ml is sufficient for the ganglion stellatum.

What is the primary approach method to the stellate ganglion?

The anterior Leriche approach is considered the most common method, although posterior and lateral approaches are also anatomically possible.

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What else to study on this topic

  • Anatomical structure of the carotid sheath and its contents
  • Mechanism of causalgic pain in injuries to limb nerve trunks
  • Complications of accidental neck vessel puncture during a block
  • Topography of the cervical sympathetic trunk and the formation of the ganglion stellatum

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