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Stellate Ganglion Block (SGB) for PTSD

Updated: Dec 20, 2023

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The Stellate Ganglion Block (SGB)

What is the Stellate ganglion exactly?

The stellate ganglion is a collection of sympathetic nerves found at the level of the sixth and seventh cervical vertebrae 9the last two vertebra of the neck) and is located in front of the vertebrae. They are part of the sympathetic nervous system and supply the face and arm. It measures about 2.5c x 1cm x 05cm in dimension. Its gets’ the name “Stellate” by its’s star shape.

What does it do? What is its purpose?

The stellate ganglion extensively connects with the brain’s cerebral cortex, hypothalamus, amygdala, and hippocampus and produces several actions.

A stellate ganglion block, blocks the sympathetic nerves that goes to the arms, and to some degree, the sympathetic nerves that go to the face. The therapeutic effects of SGB in a pain scenario are due to temporarily curbing the sympathetic autonomic nervous system and improving the blood supply of the region, which may reduce pain, swelling, color and sweating changes of the upper extremity. When used for the treatment of Anosmia/Parosmia and dysgeusia we are shutting down (blocking) the sympathetic autonomic nervous system and forcing the central nervous system to recalibrate and reset the sympathetic activation to a lower level.

Who typically gets a Stellate ganglion block:

It is typically done as a part of the treatment of Sympathetic medicated pain, Complex Regional Pain Syndrome or Herpes Zoster (Shingles) involving an arm or the head and face. But is also commonly used to treat post-traumatic stress disorder, hot flashes and sleep disturbances in breast cancer survivors.

The most common indications are complex regional pain syndrome of upper extremities, peripheral vascular disease, scleroderma and Raynaud’s disease, post surgical pain, post-traumatic stress disorder, intractable angina and refractory ventricular arrhythmias.

Other common pathology treated with SGB include:

Chronic reginonal pain syndrome I and II, Craniofacial hyperhidrosis, Refractory angina, Atypical angina, Postherpetic neuralgia, Phantom limb pain, Chronic post-surgical pain, Post-traumatic stress disorder, Neuropathic pain syndromes in cancer pain, Vascular headaches including cluster headache and migraine headache, Raynaud syndrome, Scleroderma, Upper extremity embolism, Meniere syndrome, Refractory cardiac arrhythmias, including Roman/Ward syndrome and Jervell/Lang/Nielson syndrome, To diagnose sympathetically mediated pain, Quinine poisoning, Sudden loss of hearing accompanied by tinnitus

Why would we do a SGB for the treatment of long Covid symptoms:

The over-reacting positive feedback loop of the neuro-immune-inflammation cascade are involved in the malfunction of the sympathetic nervous system and predominantly an overactive sympathetic nervous system, in the result of the constellation of long Covid symptoms. An interruption of this positive feedback loop, by a Stellate Ganglion block, can allow a “reset” and the opportunity for the body to reorganize itself through autoregulation and potentially eliminate the symptoms.

What should I expect after the stellate ganglion block?

Immediately after the injection, you may feel your face and arm, on the side of the block, getting warm. You may also notice “a lump in the throat” as well as hoarse voice, a droopy and red eye and some nasal congestion on the side of the injection.

What should I do after the stellate ganglion block?

We advise patients to take it easy for a day or so after the procedure. You can perform the activities that you can reasonably tolerate.

How long the effect of the medication last?

The local aesthetic wears off in a few minutes to an hour; however, the duration of the blockade of sympathetic nerves is not what produces the improvement in long covid symptoms… it is imply THAT we blocked the sympathetic nerves and forced a “reset”. When used for other purposes a longer duration may be preferred.

How many stellate ganglion blocks do I need to have?

If you respond to the first injection but do not obtain 100%, I will recommend a left sided injection. Usually, a series of 3-6 injections is needed to treat a pain problem. This does not seem to be needed with the treatment of Parosmia. Typically, only the initial right and left sided blocks are needed. We do not know yet if repeated injections will result in greater improvement in long covid symptoms.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, spinal block, epidural block and injection into blood vessels and surrounding organs. Fortunately, serious side effects and complications are uncommon. The ultrasound guided technique of SGB is not standard of care, the technique requires skill of US along with skill of needle tracking and neck anatomy.

Who should not have a stellate ganglion block?

If the patient is allergic to any of the medications to be injected, on a blood thinning medication, has an active infection going on near the injection site, or has poorly controlled diabetes or heart disease, they should not have the injection or at least consider postponing it if postponing it would improve your overall medical condition.

Modified from Republic Pain Specialists, P.O. Box 12257, College Station, Tx 77842, www.republic painsp.come

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