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How much experience does Dr. Lynch have with SGB?

Dr. Lynch has been performing and studying SGB for Anxiety and PTSD for over 13 years.  He has been an author on most of the original research on this topic published in the peer-reviewed medical literature.

Beginning in 2011, Dr. Lynch served as a top leader in ultrasound-guided SGBs in the military and trained numerous other physicians to perform this procedure. He has unmatched firsthand follow-up and continuity with hundreds of his SGB patients, having served in the same Special Operations community with them for over 10 years. This unique patient follow-up and close collaboration with behavioral health clinicians was pivotal in developing Dr. Lynch’s deep understanding of how best to utilize innovative SGB techniques in conjunction with trauma-focused therapy.

Dr. Lynch is routinely invited as a guest speaker and subject matter expert on stellate ganglion block.  He has lectured on this topic at several major national and international stages. He has assisted several other nations establish their SGB practices in Europe.

What is Post-traumatic stress disorder (PTSD)?

PTSD is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, combat, or rape or who have been threatened with death, sexual violence or serious injury. Some propose using the term Post-traumatic stress injury (PTSI) to de-stigmatize the term “disorder” and to indicate the biologic nature of the traumatic injury sustained which can be healed with proper treatment, such as stellate ganglion block.

Many people who are exposed to a traumatic event experience symptoms such as:

  • Being irritable or easily startled, having angry outbursts or problems concentrating or sleeping
  • Distressing dreams or repeated, involuntary memories
  • Avoiding activities and situations that may trigger distressing memories
  • Feeling detached or estranged from others or difficulty experiencing positive emotions

For a person to be diagnosed with PTSD, these symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functioning. Symptoms may appear years after the trauma and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime.

How does SGB work to help PTSD symptoms?

The Stellate Ganglion is part of the cervical sympathetic chain, a key part of the sympathetic nervous system, which is the “fight or flight” nervous system. In PTSD and some other anxiety conditions, the “fight or flight” nervous system gets stuck in the “ON” position. By precisely placing long-acting local anesthetic (ropivacaine) around the stellate ganglion, the unproductive and chronic “fight or flight” response is turned off for several hours. Dr. Lynch believes this allows the brain and the body to “reset” back to a non-anxiety state. The brain has a quality called “neuroplasticity”, which means it can actually have durable change in response to treatments like an SGB. What we do know and can measure is this “resetting” results in long-term relief of anxiety symptoms.

Can SGB help my Anxiety, even if I don't have PTSD?

Yes. Stellate ganglion block is very helpful for anxiety symptoms.
We have evaluated this use of SGB and published our results in the peer-reviewed literature in 2023. (The journal article can be found on our Evidence page).

Studying the use of SGB in 285 of our patients, we were able to cut anxiety symptom scores in half. This 50% reduction in symptoms is over twice what is considered a clinically important difference, and reinforces what our patients have been telling us for years. A related video here explains precisely WHY SGB is helpful in treating anxiety symptoms. It has to do with the anatomy and physiology of the sympathetic nervous system (SNS).

We also noted in this study that a bilateral block was more effective than one-sided SGB. This was the first study to demonstrate that an SGB on one day followed by an SGB on the opposite side on the following day provided more relief than a single-sided SGB.

What symptoms does SGB treat?

Dr. Lynch has used SGB to successfully treat Anxiety and PTSD symptoms for over 13 years. He researched and published evidence which describes which specific symptoms seem most improved from SGB. While many people improve in a variety of their symptoms, the symptoms of “hyperarousal” improve dramatically for most. These symptoms, caused by a stimulated sympathetic nervous system, include irritability, angry outbursts, and poor sleep. The physical symptoms which accompany re-experiencing traumatic events (“flashbacks”) including racing heart, sweating, and increased body tone are also sympathetically driven and improve greatly after SGB. We know that these symptoms can be debilitating, ruin relationships, and serve as barriers to effective therapy.

In another study published in 2024, Dr. Lynch and his colleagues also demonstrated the first evidence supporting the successful use of SGB to treat concussion/traumatic brain injury (TBI) symptoms. More research is needed in this area; however, preliminary results are very promising for those suffering from post-concussive symptoms like headache and brain fog.

What are the risks of an SGB procedure?

The overall risks of having a significant adverse event are very small (much less than 1 in 1000) when performed by a skilled provider with ultrasound guidance. There is a very small risk of a seizure from inadvertently injecting the local anesthetic into a blood vessel.  There is an extremely small risk of forming a dangerous hematoma (collection of blood from a bleeding vessel).  This risk is very small in people not taking blood thinning medications. SGB should not be done in people currently on blood thinning medications.  About 20 percent of the time after a block, some patients get a hoarse voice or feel like there is something in the back of their throat. This occurs when the anesthetic spreads to another nerve near the larynx. This is not a mistake, it just happens sometimes. The hoarse voice or feeling in your throat, if it occurs, will wear off in 3-6 hours.

What is the percentage of success?

Dr. Lynch carefully screens potential patients to select those that have the best chance of having success with SGB.  In a properly selected patient, the published success rate is over 85% (defined by significant improvements in the PCL-5 score).
Performing an SGB on both sides seems to be more effective than an SGB on one side alone based on recent research.

How many treatments does it usually take?

About one third of patients are successfully treated with a single SGB and do not need another SGB. There is no “requirement” to repeat an SGB. In other words, the benefits do not “require” repeat SGBs at some regular interval to sustain the benefits. However, many people elect to repeat an SGB treatment later on if they experience some return of symptoms. Some people may be exposed to conditions that “re-trigger” their PTSD symptoms, or others may simply hit a “rough spot” in life that may elevate their anxiety symptoms.

SGB can be safely repeated if it was helpful the first time, and typically each subsequent SGB is as helpful as the first. Completing follow-up symptom surveys at one week and one month after your SGB is very useful to quantify your benefits and may help determine if and when another SGB would make sense for you.

Do I need to be sedated?

No. Sedation actually significantly increases the risk of this procedure.

Dr. Lynch has performed approximately 2000 SGBs over the past 12 years and has never used sedation on any patient. This procedure is NOT painful. Most patients describe it as a 1/10 for pain. Dr. Lynch does not rush and will talk you through everything. Even people who don’t like needles do fine.

Why is an ultrasound-guided SGB more effective?

Ultrasound allows the needle to be safely guided around the nerves and blood vessels in the neck as it is placed next to the stellate ganglion. Under x-ray (fluoroscopic) guidance, only bones are visible, so nerves are not visible at all and their position can only be approximated. Using ultrasound guidance to safely perform an SGB takes special training and considerable skill, which many pain medicine trained physicians do not have. Ultrasound allows you to actually see your target as well as avoid major blood vessels and nerves. This makes the procedure safer, less painful, and significantly more precise under ultrasound than under fluoroscopy.

At what cervical vertebral level does Dr. Lynch perform the SGB?

Dr. Lynch now routinely performs SGB at both the 4th and 6th cervical vertebral levels (C4 and C6) at the same time.  This could be more appropriately called a “Cervical Sympathetic Block” because the whole cervical sympathetic trunk (CST) is anesthetized.  This is more effective because we can block the smaller sympathetic fibers which exit the CST at levels above the stellate ganglion too.

There are well-referenced anatomical differences in how a person’s sympathetic chain courses through their neck which may explain the additional benefits of a two-level block in some patients.

How does Dr. Lynch evaluate if the SGB was successfully performed?

Following a successful stellate ganglion block, there are obvious physical changes on your face–called Horner’s syndrome–that Dr. Lynch evaluates, scores, and documents in your record. This guarantees that the procedure is properly performed 100% of the time. You can see this for yourself and be confident that your SGB was performed properly.

Horner’s syndrome is a series of temporary changes that happen on the side of the face that was blocked after the “fight-or-flight” nervous system has been successfully turned off. Some of the changes are easily visible and include: a droopy eyelid, a smaller pupil, and a bloodshot eye. These changes last about 8 hours, which is the duration of the anesthetic used (ropivacaine).

Below is a picture of a typical Horner’s syndrome response. This is to be expected and indicates that your SGB was performed successfully.

What should I do for optimal results Post-Stellate Ganglion Block (SGB)

See attached pdf:

Post-SGB Care PDF

What should I do if the initial SGB provided on the right side C6 does not provide the results that I had hoped for?

Although SGB has been demonstrated in the medical literature to provide durable relief of anxiety symptoms associated with PTSD, no therapy is 100% effective for all patients. A patient may have other medical conditions affecting their anxiety symptoms which may not respond to treatment with SGB. However, if they are a good candidate for this therapy, (PTSD diagnosis with an elevated PCL-5 score) and they fail to respond to a right-sided SGB, then the patient should consider a left-sided SGB. This must be done at least one day later for safety reasons. (NEVER have a block on both sides of the neck within a 12-hour period; in theory this could result in a fatal blockage of the airway).

Although the exact figure is not known at this time, about 1-5% of patients will not respond to a right-sided SGB but will respond profoundly to a left-sided SGB. Dr. Lynch studied this effect and published these encouraging results in 2020.  Our data suggests that some people, perhaps as high as 20% of people, even if they partially respond to a right sided SGB, may have a more profound response to a left-sided SGB. This appears to be the case because some people have anatomic differences in how their “fight or flight” system is wired. If they fail to respond to a properly performed SGB with a good resulting Horner’s on the right or left side, then SGB is not an effective therapy for this patient and further SGBs should not be attempted.

How might SGB improve sexual functioning?

Studies show that high levels of anxiety from any cause, (including PTSI), can directly affect sexual functioning in men and women. Imagine someone running from a tiger; their anxiety and stress levels are so high that sexual arousal is virtually impossible. Decreased arousal capacity has to do with elevated levels of an excitatory hormone called norepinephrine in the fluid surrounding the brain. Experiencing the loss of normal sexual function may produce significant anxiety, which adds to the total burden of anxiety and contributes to stress on relationships. An SGB has been shown to significantly reduce a person’s total anxiety and can result in the return of normal sexual functioning. 

Does SGB help with Traumatic Brain Injury (TBI)?

Although there is currently no published medical evidence supporting this, in our clinical experience, we have been seeing significant improvement in some TBI symptoms, such as chronic headaches, when SGB is done on the right side followed by SGB on the left side the next day.  Again, this is not supported by published research and represents our current expert opinion based on thousands of patients we have treated with SGB.

For critical safety reasons, the right SGB and the left SGB should be done on different days. In published human research studies, SGB causes temporary changes in blood flow to the brain, and this may contribute to the benefits we see clinically.

What does SGB NOT treat?

SGB is not a specific treatment for Autism, Bipolar disorder, Schizophrenia or any variants of Schizophrenia, Personality Disorders or Seizure disorders. However, people with these conditions may ALSO have PTSD and anxiety. SGB can still be very helpful IF they also have PTSD or anxiety symptoms.

It is important to note that your symptoms may be more helpful than your diagnosis here. We will continue to research what works best for whom and how to incorporate SGB into other treatment modalities.

Are you treated in the same appointment as the screening?

Everyone is screened prior to being scheduled. No additional appointment is needed for screening.

Can I drive after the procedure?

The accepted medical practice is that you cannot drive for 8 hours after this procedure. Please plan to have a driver with you or use a driving service like Uber.

Where is the closest airport?

Baltimore Washington International Airport (BWI) is the closest airport and is 25 minutes to the North. Reagan International Airpot (DCA), is 50 minutes away, and involves traveling on the 495 Beltway, which may have heavy rush hour traffic. Dulles International Airport (IAD), is approx 1.5 hours away and also subject to heavy traffic. There are many lodging options in the greater Annapolis area. Ask our front desk for more information.

What are the lodging options in the Annapolis area?

Lodging options can be found here.