Stellate ganglion blockade, typically performed by using palpable osseous landmarks, is an accepted method in the diagnosis and treatment of sympathetically maintained pain and other conditions. The authors present the results of stellate ganglion injection performed with computed tomographic (CT) guidance. Thirteen CT-guided procedures were performed in seven patients. Lidocaine, bupivacaine, and buprenorphine were used to achieve the blockade. Successful blocks were achieved in all 13 cases as evidenced by production of Horner syndrome and ipsilateral hand temperature elevations. The average ipsilateral and contralateral hand temperature changes following the procedure were 7.5 degrees C and 0.5 degrees C. The ipsilateral hand temperature changes and the differences between the ipsilateral and contralateral hand temperature changes exceeded 1.5 degrees C in every case. Five patients preferred the CT-guided procedure over the conventional technique, and two patients noted no substantial difference between the approaches. With the CT-guided technique, a highly effective sympathetic block is achieved with a substantially reduced volume of anesthetic compared with the conventional approach.