What is a Stellate Ganglion Block (SGB)? 
 
A stellate ganglion block is a minimally invasive procedure that involves injecting 3-5ml 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, with most sessions completed in under 30 minutes, 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. It’s not just about managing symptoms—it’s about rediscovering joy and functionality.
 
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 block (SGB) in posttraumatic stress disorder (PTSD) are still being researched, but several theories have been proposed:
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 in PTSD through a combination of neurobiological and physiological mechanisms. Further research is needed to fully understand the role of SGB in PTSD treatment and optimize its clinical application.
 
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 day 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.
 
Risks and Side Effects

While SGB is generally safe, like any medical procedure, 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 resolve on their own.
            
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, or surgical interventions. For those considering their options, alternatives include medication, cognitive-behavioral therapy, physical therapy, and other nerve block procedures. We believe in a comprehensive approach to wellness and encourage discussions on the best path forward for each individual. However, SGB stands out for its efficacy, minimal invasiveness, and rapid onset of relief.
 
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. Emerging studies underscore the efficacy of SGB in treating emotional and physical distress, highlighting its role as a promising intervention in the field of pain management and mental health. Researchers are excited about its potential, continually investigating its wide-ranging benefits. There is some very loud debate about whether 1 or 2 shot work best, there is no published data showing 2 shots are better than one, and 2 shots can increase risk, we usually do the 1 shot block, to maximize benefit and minimize risks, but we are able to provide the 2 shot block, if requested.
 
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.