Stellate Ganglion Block

Stellate Ganglion Block (SGB) is a safe procedure that has been in wide medical use since the 1920’s. An injection of a long-acting local anesthetic is placed around a collection of nerves located on the right side of the neck. These nerves control the “fight or flight” response of the sympathetic nervous system. The Albany Clinic performs SGB using ultrasound guidance, a state-of-the-art technology that allows for better visualization of anatomical structures.

The stellate ganglion is a collection of nerves that is located in the neck, on either side of the voice box. A stellate ganglion block is an injection of local anesthetic into these nerves. Because these nerves are part of the “fight or flight” sympathetic nervous system, placing an anesthetic agent or “blocking” these nerves can relieve the symptoms of PTSD.

Lying face up on our treatment table, an intravenous catheter (IV) with saline will be started and medication to relax you will be given. The skin on your right shoulder and neck will be cleansed and sterile ultrasound gel applied to the neck. The right side of your neck will then be scanned with ultrasound for the location of the injection site. Using real-time ultrasound guidance, the needle will be guided to the stellate ganglion and the medication will be slowly injected over 2-3 minutes. After the injection, you will continue to lie flat for 5 minutes, upon which at that time the effects of your SGB will be assessed. After the procedure is completed, you will be observed in the clinic for another 30-45 minutes before being allowed to go home. All patients will need to be accompanied by an adult who can drive them home after discharge. You should not drive or operate heavy machinery the day of the procedure. You may return to normal activities the following day.

What are the risks?

When performing an SGB, we expect a temporary condition referred to as “Horner’s syndrome” to occur- 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.

In about 20% of the cases, patients also experience a “hoarse voice” or feel as if something is in the back of their throat. This happens sometimes and it is temporary. If this happens, take a few careful sips of water and make sure you are swallowing normally. The SGB has few additional side effects. Patients may report mild soreness at the site of injection that is temporary and will not require any treatment. Any additional risks or concerns will be discussed with the physician prior to the procedure.

Relief of PTSD symptoms is usually rapid and immediate with Stellate Ganglion Block. SGB has been shown to be clinically effective in symptom reduction of PTSD in 90% of patients. Additionally, relief from these symptoms from a single injection has been shown to last from several weeks to months. This is in contrast with traditional treatment with selective serotonin reuptake inhibitors (SSRIs/SNRIs) such as Zoloft and Paxil which are often only 20-30% effective and take at least 6 weeks before treatment response can be evaluated.

Stellate Ganglion Block is an appropriate consideration for those suffering from PTSD symptoms, particularly if the dominant symptoms are hypervigilance and heightened reactivity. A consultation will determine whether Stellate Ganglion Block is a good option for you.