Patient Procedure Documents

We need to make sure that your procedure is appropriate for you. If you are scheduled for a stellate ganglion block you must fill out a questionnaire called a PCL-5 and a basic medical questionnaire. If you are scheduled for an IV infusion therapy, you will only need to fill out the basic medical questionnaire.

After we have discussed your procedure, its potential benefits and its potential risks, and you have had your questions answered, you will need to sign an informed consent.

What to expect and how to prepare for your procedure

Let us know during your consultation if you are taking anticoagulant medication (blood thinning medication that prevents you from forming blood clots), and we will discuss when to stop taking them prior to the procedure. Also, let us know if you have any allergies to medicines. Do not eat or drink after midnight on the day before the procedure unless you have been instructed otherwise.

The day of the procedure

On the day of the procedure, you will need to arrange for a driver to take you home. If you are having an SGB, wear a top that can be removed easily or one that will completely clear the right shoulder and neck. Wear a loose fitting short sleeve top. If you would prefer, a loose-fitting gown can be provided. Remove any necklaces or large earrings. After an SGB, your right eye will look droopy for about 4-8 hours after the procedure, so do not schedule any important photos of your face on that day.

During the SGB procedure

You will lie face up on our treatment table with your right shoulder and neck exposed. An intravenous catheter (IV) will be inserted and a saline solution will be started. The skin on your right shoulder and neck will be cleansed with an antiseptic surgical skin preparation and sterile ultrasound gel applied to the neck. The right side of your neck will then be scanned with ultrasound and the collection of nerves identified. Once the nerves have been identified, medication for sedation will be administered as indicated (most patients will require some level of sedation), and a small amount of local anesthetic will be injected in the skin to make the procedure more comfortable. Using real-time ultrasound guidance, the needle will be guided to the stellate ganglion. Once the needle is at the target, a long-acting anesthetic will be slowly injected over 2-3 minutes. During the injection, Dr. Garwin will ask if you are doing ok, if you are having a metallic taste in your mouth, or if there is ringing in your ears. It will be safe to answer questions, otherwise you should refrain from talking or moving during the procedure. Once the needle is removed you will continue to lie flat for 5 minutes, then you will sit up and have your SGB assessed. When an SGB is performed and the sympathetic nerves are blocked, we are looking for a temporary condition referred to as a “Horner’s syndrome”- your right eyelid will be droopy, your right pupil will be smaller than the other pupil, and the white part of your right eye may get red. This is a normal part of the block and will wear off in 4 to 8 hours. After the procedure is completed, you will be observed in the clinic for another 30-45 minutes before being allowed to go home.

During the IV Drug Infusion Therapy Procedure

You will be seated in a reclining chair, an IV catheter will be inserted, and a saline infusion will be started. Monitors will be applied and oxygen will be administered. The IV Drug Infusion Therapy will be initiated through the IV catheter and will require 45 to 60 minutes to complete. During the infusion, most patients will drift off to sleep and will be awakened at the conclusion of the procedure.

After your procedure

Plan on taking it easy for the rest of the day and you should not drive or operate heavy machinery on the day of the procedure. Following the procedure you may eat whatever you feel that you can tolerate, but you should begin with liquids. Although complications with SGB are exceedingly rare, if there is pain that is getting worse in your neck or you experience shortness of breath, these could be signs of a more serious complication. If this should occur, you should contact 911 or go to your local emergency room and tell them that you had an injection in your neck performed that day. After an IV Drug Infusion Therapy, if you experience worsening psychological symptoms and/or suicidal ideation contact 911 or go to your local emergency room. Most people feel the results of an SGB within an hour. Keep track of the symptoms that were bothering you and make note of any differences. Fill out another PCL-5 questionnaire and email it to the Albany Clinic at one week after your injection so that we can track how you responded to the SGB. Many patients get sustained relief of their symptoms and do not need further treatment, but in some patients symptoms may be re-triggered and re-occur. If this happens and the block helped you previously, the SGB may be repeated. Do not let your symptoms fully return before seeking treatment. If you notice a regression of your symptoms, seek help by calling the Clinic or contacting your mental healthcare provider. SGB is not intended to be a stand-alone treatment for significant PTSD and it needs to be part of a treatment plan that is integrated with other modalities by your mental healthcare provider. Most patients get significant relief almost immediately after receiving IV Drug Infusion Therapy. Monitor your symptoms that were bothering you and make note of any new or different symptoms. Contact us within a few days following your infusion so that we can track your response to treatment. Some patients may get sustained relief of their symptoms and will not need further treatment, but patients often require more than one IV Drug Infusion Therapy, especially if their symptoms are retriggered or reoccur. If you notice a regression of your symptoms and would like another drug infusion, seek help by contacting the Clinic or your mental healthcare provider. IV Drug infusion therapy is not intended to be a standalone treatment for Treatment-Resistant Depression and needs to be a part of a treatment plan that is integrated with other treatment strategies by your mental healthcare provider.

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We offer your initial consultation free of charge! To schedule a consultation please fill out our contact form. Consultations do not require a referral, however candidates for treatment need to be in the care of a mental healthcare provider. For general inquiries please contact us via phone or email.