Stellate ganglion block is an interventional procedure for blockade of sympathetic innervation to head, face, neck and upper extremity. It provides good diagnostic, prognostic and therapeutic value in select chronic pain syndromes which are sympathetically mediated. Although it was performed in a blind fashion for several decades after initial description in early twentieth century, it is now considered essential to use image guidance to guide the access to stellate ganglion due to its vicinity to several vital structures in the neck. Fluoroscopy is at present the most commonly used modality although ultrasound guidance might soon override its usage. It can be a very useful intervention for Complex Regional Pain Syndrome, Post herpetic neuralgia, Phantom pain, Post mastectomy pain and Circulatory insufficiency. Good response to a diagnostic local anaesthetic block may be followed by a series of similar blocks or Radiofrequency neurotomy for long-term remission of pain. The most feared complications of Stellate ganglion block are seizures due to intravascular injection, pneumothorax and Intra spinal injection. T2-3 sympathetic block may be warranted in 20% of individuals who may fail to respond to Stellate ganglion block due to presence of Kuntz’ fibres which bypass the Stellate ganglion.