Stellate Ganglion Blocks

A procedure that targets the sympathetic nervous system, which provides rapid and durable relief from symptoms of PTSD, hypervigilance, anxiety, and some other conditions for many people

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Syringes and tubing used for Stellate Ganglion Block (SGB) treatment

Immediate & Durable

SGBs may provide immediate relief from symptoms of hypervigilance, PTSD, and severe anxiety, among other conditions

Results often last 2-6 months or longer

Rapid & Effective

SGBs are a quick procedure that can be administered in 15 minutes or less

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70-80%

of appropriate patients experience a decrease in symptoms of PTSD

Symptoms of anxiety may be reduced by more than

50%

Physician pointing to ultrasound imaging used for a stellate ganglion block.

What it looks like

A Stellate Ganglion Block targets sympathetic nerve clusters that affect the ‘fight or flight’ response and our bodies’ response to perceived danger

Injections of long-acting anesthetic are administered at C4 and C6 in the neck to temporarily block the stellate ganglion

What is a Stellate Ganglion Block (SGB)?

The Stellate Ganglion Block is also often referred to as SGB, sympathetic nerve reset, or sympathetic block. The procedure targets sympathetic nerve bundles in the neck – which affects the ‘fight or flight’ response and our bodies’ response to perceived danger. For some patients the procedure can provide significant relief from symptoms of Post Traumatic Stress Disorder (PTSD) and may be helpful for some other conditions – with recent results supporting its use in reducing symptoms of anxiety.

Why Choose Stellate Ganglion Blocks?

Stellate Ganglion Blocks can provide immediate, significant and persistent relief in some cases. These blocks may be particularly useful for PTSD – providing immediate relief from symptoms for many patients which can last for days, weeks or months (and possibly longer). Results appear to last for 2 to 6 months in many cases. The block procedure is short and cost-effective and you can return to your normal activities shortly after your appointment.

The Procedure

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PREPARATION

You will fast for a few hours leading up to your appointment. When you arrive at the clinic, we’ll meet with you in a private treatment room to discuss the SGB treatment, go over any questions or concerns you have, and review other holistic changes that may be helpful to improve your symptoms and increase the benefit you see from treatment.

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TREATMENT

The SGB procedure itself is very brief, lasting only a few minutes. You’ll lay down on the treatment bench with your head resting to the side to expose your neck. We use an ultrasound probe along your neck to identify anatomical markers of the stellate ganglion block and to guide the needle for the block.

After we’ve identified these anatomical markers, we numb the skin and administer the block. The stellate ganglion block consists of two injections of long-acting anesthetic near the C4 and C6 vertebrae along the neck.

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RECOVERY

After you’ve received your SGB, you can sit back up and will rest with us for 30 minutes of observation. We expect to see temporary side effects emerge during this time that will occur on the same side of the body as the block.

These side effects, known as Horner’s syndrome, include redness and droopiness of the eye, stuffiness in the nasal cavity, and a thick throat or difficulty swallowing. Side effects will feel most intense in this initial 30 minute period and generally fade over the course of 8-12 hours.

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RELIEF

Some patients experience symptom relief almost immediately after the block is administered, often described as a feeling of calm or quiet. For other patients, these changes are more subtle and it may take time to notice the benefit of treatment.

For patients who do not notice any changes following their SGB, we suggest they try a new block on the left side of their neck. While most patients experience relief primarily from a right-sided block, some patients respond most to a left-sided block. Other patients prefer to treat both sides and receive the most benefit from bilateral treatment.

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MAINTENANCE

The relief provided by a stellate ganglion block generally lasts 2-6 months. However, some patients report that they experience relief indefinitely.

To sustain the benefit of treatment, we suggest returning for a maintenance block every 2-6 months or when symptom relief fades.

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Call (713) 589 – 5118
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Exceptional Care that Makes a Difference

Here at Wells Medicine, we are experts in anesthesia including blocks of all kinds — with a particular focus on the Stellate Ganglion Block — leveraging our experience with interventional mental health procedures for the benefits of our patients. We’re invested in treatments that are evidence-based, providing them in a safe and compassionate setting, and supporting your care. 

What Our Patients Say
“My fight or flight anxiety has dramatically decreased. This is by far the most effective treatment I’ve found. Dr Wells is very experienced with administration of this relatively new treatment and I have complete confidence in her ability.”
– Patient Testimonial
“I was a bit nervous because the nerves are located in your neck. She put my mind at ease and the procedure was not painful at all, just a weird is the best way to describe it. Dr Wells is really thorough and caring. Great bedside manner and highly knowledgeable.”
– Patient Testimonial
“I went to Wells Clinic today for a SGB. The procedure was performed with so much Care and expertise. Dr. Wells took precious time, extra time with me to ensure I got the most out of my treatment. I would give Dr. Wells & her staff 10 Stars if I could.”
– Patient Testimonial
“I’m a veteran and I’ve lived with PTSD, anxiety, and depression for over two decades. It’s day two after my second SGB at Wells Medicine, and I honestly didn’t think it was possible to feel this calm and at peace again.”
– Patient Testimonial
“Finding Dr wells has changed my life in just a few short days. She was extremely kind and patient, and ultimately restored my faith in the medical system. After the injection my racing thoughts were gone and I felt an overwhelming peace I had never felt…”
– Patient Testimonial
“PTSD was breaking me – but now I feel like I have my life back. The Stellate Ganglion Blocks with Dr Wells and Wells Medicine are the best thing I’ve done in a very, very long time.”
– Patient Testimonial
“After receiving an SGB shot and starting infusion therapy, I started to feel a noticeable difference both mentally and physically. The second SGB shot made me feel even better and significantly reduced my anxiety. My migraines have improved, and for the first time in years, I feel more hopeful about my future.”
– Patient Testimonial

Common questions

More on Stellate Ganglion Blocks

A stellate ganglion block is procedure that involves injecting small amounts of a long-acting local anesthetic near the stellate ganglion, a cluster of nerves located in the neck. Performed by a skilled practitioner, the procedure involves the careful insertion of a needle under ultrasound guidance to ensure accuracy. The process is quick, allowing patients to return to their daily activities with minimal downtime. It is a cutting-edge solution for individuals seeking relief from Complex Regional Pain Syndrome (CRPS) of the upper extremity, Post-Traumatic Stress Disorder (PTSD), certain vascular conditions, and anxiety. This is a very old and well-studied block and has been used safely and successfully for pain conditions long before ultrasound was developed. Its benefits for mood began to be studied more than a decade ago and additional research has increasingly demonstrated its efficacy for mental health conditions and symptoms.

The stellate ganglion block (SGB) is FDA-approved for the treatment of certain pain syndromes. Its use for psychiatric conditions is considered an off-label application. Individual results vary. The procedure should not be considered a replacement for medication management, psychotherapy, or other standards of care.

What does SGB treat?

PTSD / Post-Traumatic Stress Disorder

Severe anxiety

Long COVID

Phantom limb

CRPS / Complex Regional Pain Syndrome

PHN / Postherpetic neuraligia

TBI / Traumatic Brain Injury

& other conditions

How does it work?

For pain: The stellate ganglion plays a crucial role in regulating sympathetic nervous system outflow which affects the blood flow, temperature, and pain perception in the head, neck, and upper extremities. By blocking signals from this nerve cluster, SGB interrupts the pain cycle, providing effective relief for patients. 

For mood: The exact mechanisms underlying the efficacy of stellate ganglion blocks (SGB) for mood continue being researched. The most well-studied use of SGB for mental health is for Post-Traumatic Stress Disorder (PTSD).

1. Modulation of Sympathetic Nervous System:

The stellate ganglion is a part of the sympathetic nervous system, which is involved in the body’s “fight, freeze, or flight” response. By blocking the activity of the stellate ganglion, SGB may reduce sympathetic nervous system hyperactivity observed in individuals with PTSD. This can lead to decreased arousal, anxiety, and alleviation of other PTSD symptoms.

2. Alteration of Neurotransmitter Levels:

SGB may influence the levels of neurotransmitters involved in PTSD. By modulating the release or activity of these neurotransmitters, SGB could potentially alleviate PTSD symptoms such as hyperarousal and intrusive thoughts.

3. Normalization of Brain Activity:

Functional imaging studies have shown abnormal activity in certain brain regions, such as the amygdala and prefrontal cortex, in individuals with PTSD. SGB may help normalize this activity by modulating neural circuits involved in fear processing and emotional regulation, although we don’t have a verified pathway for how this happens yet. 

4. Reduction of Neuroinflammation:

There is evidence to suggest that neuroinflammation plays a role in the pathophysiology of PTSD. SGB may have anti-inflammatory effects, leading to reduced neuroinflammation and improvement in PTSD symptoms.

5. Enhancement of Fear Extinction:

Fear extinction is the process by which learned fear responses are diminished over time. SGB may enhance fear extinction by modulating synaptic plasticity mechanisms in the brain, facilitating the extinction of traumatic memories and reducing the severity of PTSD symptoms. This is facilitated by therapy in the days and weeks after a SGB. 

Overall, while the exact mechanisms of action are still being elucidated, SGB appears to exert its therapeutic effects on PTSD through a combination of neurobiological and physiological mechanisms.

Benefits of SGB

Rapid Relief:

Many patients experience immediate or significant pain and PTSD symptom reduction following the procedure. The effects can be both immediate and profound, offering a window of relief that has been described as transformative by many patients.

Minimally invasive:

SGB is performed on an outpatient basis, minimizing downtime and discomfort. Usually the right side SGB is enough for PTSD relief, but occasionally both sides need to be blocked for the best effects and a left side SGB can be done a day or two after the right side for increased effectiveness.

Enhanced quality of life:

By managing pain and PTSD effectively, SGB empowers individuals to regain functionality and enjoy daily activities. Relief often lasts several weeks to months.

Innovative Approach:

At the forefront of medical science, SGB offers hope where traditional treatments may have failed.

Versatility:

Effective for a range of conditions, including PTSD, anxiety disorders, and various types of chronic pain.

Review the Evidence

Risks & Side Effects

While SGB is generally safe, as with medical procedures, it carries some risks, including:

Expected: Temporary (<24 hours) hoarseness or difficulty swallowing, a slight drooping of the eyelid and face, and a redness to the eye on the same side of the face as the block – these effects are typically short-lived and are expected to resolve on their own within 24 hours.

Possible: Temporary minor bruising or soreness at the injection site, 

Rare complications: infection, nerve injury or damage, or esophageal puncture, allergic reactions to the local anesthetic, seizures, temporary decrease in heart rate and blood pressure, bleeding or hematoma formation

Remember, the effectiveness and suitability of SGB vary from person to person. It’s crucial to consult with a healthcare professional to discuss the potential benefits and risks based on individual health profiles. 

Alternatives to SGB

Depending on the condition being treated, alternative therapies may include medication management, physical therapy, nerve blocks, and psychotherapy. We believe in a comprehensive approach to wellness and encourage discussions on the best path forward for each individual. SGB stands out for its efficacy, minimal invasiveness, and rapid onset of relief, and may be an excellent addition to your treatment plan.

Research

Recent studies have highlighted the effectiveness of SGB in treating not only physical pain but also psychological symptoms associated with PTSD. Research published in leading medical journals such as Pain Medicine and Journal of Pain Research underscores SGB’s role as a versatile and promising intervention in pain management and mood disorders.

Learn more about Stellate Ganglion Blocks

SGB Blog Posts

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References

Kirkpatrick K, Khan MH, Deng Y, Shah KB. A Review of Stellate Ganglion Block as an Adjunctive Treatment Modality. Cureus. 2023 Feb 19;15(2):e35174. doi: 10.7759/cureus.35174. PMID: 36949968; PMCID: PMC10029323.

Singh, Heena; Rajarathinam, Manikandan. Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions. Journal of Anaesthesiology Clinical Pharmacology 40(2):p 185-191, Apr–Jun 2024. | DOI: 10.4103/joacp.joacp_304_22

Lynch JH, Mulvaney SW, Bryan CJ, Hernandez D. Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. Journal of Personalized Medicine. 2023; 13(6):958.