In this video, Dr Wells goes over what a Stellate Ganglion Block is, how it works, how long it lasts, and what to expect from treatment.
Watch the video and see the summary below.
What it is and How it Works
The Stellate Ganglion Block, or SGB, is a nerve block procedure that can help people suffering with PTSD, anxiety and people with other symptoms of heightened and uncontrolled hyperarousal.
The word stellate ganglion block (SGB) can be broken down into:
Stellate – star-shaped
Ganglion – bundle of nerves
Block – nerve block
The stellate ganglion is a star-shaped bundle of nerves located next to the carotid artery in the front of the neck. This nerve bundles is basically the nerve highway for the sympathetic nervous system.
A nerve block is an injection of medication that turns off the electrical signals that nerves use to transmit information. Medications like novocaine, lidocaine, and other drugs that end in “-caine” decrease the transition of nerves’ electrical signals. Nerve blocks are typically used by anesthesiologists to control pain for surgical procedures or by pain doctors for people with chronic pain. Most people who have had dental work have had a nerve block at the dentist to numb the affected area for the procedure.
For a stellate ganglion block, we typically use bupivacaine – a very slow onset and offset medication – to block the sympathetic nervous system for about 24-36 hours. Once this medication is in place, the sympathetic nervous system turns off and ‘reboots’ when it comes back online.
The stellate ganglion block ‘decreases’ the sympathetic nervous system and may allow that reset to help patients go on about their lives without the disruptive level of hypervigilance and physical symptoms.
Who is a Good Candidate
Patients who are suffering from symptoms of hypervigilance, PTSD with physical symptoms, racing heartbeat, sweating, constant checking, nervous energy, or restlessness, may be good candidates for a stellate ganglion block. Patients who have told us they’ve “done all the therapy in the world” and can intellectualize their anxiety or trauma but can’t get rid of the physical symptoms, may be particularly good candidates.
How long it Lasts
About 80% of people see a reduction of negative symptoms with a stellate ganglion block. For these people, they often notice positive results almost immediately. Before they even leave our office, patients often tell us, “there’s quiet”, “it feels so different”, “I’m so relaxed”, or “I don’t feel that racing energy”.
Generally, this feeling lasts from 2 to 6 months. Treatment results will be better, and longer lasting, with lifestyle changes such as therapy, regular yoga or exercise, adding in magnesium and vitamin D, changing your diet to a less processed diet, meditation, or journaling.
Right side or Left Side Or Both
Usually, we start with a right-side stellate ganglion block. More people respond to a right-sided block vs a left-sided block, and it is typically the initial block due to the high efficacy. About 80% of patients who respond to an SGB respond to the right side.
The left-sided block is typically used to bolster symptom relief. It may also result in symptom reduction for some people even if the right-sided block has no or minimal effect. If the right side doesn’t cause that “boom” big response that we like to see, we can often get that response from a left-sided SGB. On its own compared to the right-sided block, the left-sided block is usually a bit less effective, so it is rarely used as the initial block.
A combined, or bilateral, block protocol has the highest efficacy. Pursuing both blocks, on each side of the neck, is the most likely way to get strong and durable results. The two blocks must be done on separate days.
Many patients ask why they can’t just get both sides done at the same time to increase their chance of success. This is not advisable for multiple reasons:
Side effects that indicate a stellate ganglion block is working correctly include difficulty swallowing and a hoarse voice. Doing both sides of an SGB at the same time could be quite dangerous because these side effects would intensify.
Similarly, we don’t perform blocks on both sides of the neck for the same reason cataract surgery is not performed bilaterally in the same day – if there is a bad outcome for any reason it is vastly preferable to have a bad outcome on only one side and not both. Bad outcomes are relatively uncommon, but we want to approach this procedure with appropriate caution.
Spacing both sides of a block can also be beneficial because we can learn how you respond to each side. Different people respond differently to the two sides. Although this effect has nothing to do with your dominant hand, it may be helpful to think of it like how most people are right-handed, some people are left-handed, and some are ambidextrous.
When the stellate ganglion block is working correctly to block the sympathetic nervous symptom, there are some effects we expect to see. These side effects can be discomfiting if a patient is not expecting them.
These side effects occur on the same side of the body as the SGB, and include:
Side Effects
- A droopy face
- Redness in the eye
- Constricted pupil, leading to uneven vision
- Numbness on the side of the neck
- Thickness to the throat or swallowing
- A hoarse voice
- Weakness in the arm and shoulder
What the Procedure Looks Like
We ask patients to refrain from eating and drinking for about 6 hours before an appointment. We also ask that you arrive about 15 minutes before your scheduled appointment time to ensure that we are able to maintain a timely appointments, as much as possible.
An office visit for SGB typically takes 60 to 90 minutes. It starts with check in and paperwork. The doctor speaks with you before the block to review important information, to go over recommendations for holistic and lifestyle changes for treating your symptoms, and to discuss any questions or concerns you may have. She’ll then ask you to lay comfotably on the procedure table and numb the target area. When the numbing agent has taken effect, The block itself takes about 5 minutes. After the block, we ask you to sit with us for around 30 minutes as the block ‘sets up’.
Immediate side effects from the block start immediately and peak roughly 15 or 20 minutes after the block. After sitting with us for about 30 minutes, all of the changes we expect to see from the block will have started settling in and having their effect. We don’t want you to leave prematurely – we like to be able to check with you during this period.
Patients are free to resume their normal activities after the procedure, including driving themselves from their visit. The side effects should dissipate over the course of the day and should be largely resolved by the following day. Side effects occasionally take longer to resolve.
More procedure Details
We use ultrasound-guided imaging for block placement, with an ultra-compact hand-held ultrasound unit and a reflective needle designed for this purpose. It is possible to do the block ‘blind’ (using manual manipulation and visible landmarks) or with fluoroscopy (real-time x-ray) but ultrasound is the ideal method to guide the block placement.
We perform multi-level injections for each block, targeting the C6 and C4 cervical levels for maximal efficacy.
Risks
Although they may be uncomfortable, none of the aforementioned side effects are dangerous – just things we watch out for. There are, however, some serious risks associated with a stellate ganglion block, particularly as the neck is a ‘valuable real-estate area’ of the body.
This block has been done since the 1800’s just by feel, in what is described as a “blind block”, to treat conditions other than PTSD. Since that time, ultrasound technology has made it so that doctors can directly see what they are doing and avoid important anatomy in the neck. This technology has made the dangerous risks of a SGB very rare, and the procedure very safe.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
