Over 450+ 5-Star Reviews on The cost of an SGB with Dr. Lynch is $800 for a two-level block on the same side (both C6 and C4). 1 side = $800.
The cost of a bilateral SGB with Dr. Lynch is $1600 total. This is performed on BOTH the right and left sides (which requires 2 appointments with at least 12 hours between procedures). Research shows that treating both sides provides a larger benefit for most people. Both sides = $1600 total.
Most insurances do not cover SGB as a treatment for PTSD or Anxiety. This means that you will most likely have to pay for your procedure out-of-pocket.
Yes, we do offer the Care Credit payment plan (6-month interest deferred option). To apply for Care Credit go to: https://www.carecredit.com/
Dr. Lynch provides procedural expertise, but perhaps equally important, he provides 15+ years of personal experience performing SGB, quantifiable published outcomes on hundreds of his personal patients, and lessons learned from his extensive network of behavioral health colleagues–this is what you get with Dr. Lynch.
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.
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 assault or who have been threatened with death, sexual violence or serious injury. The term disorder refers to a condition that disrupts normal body or mind functions, such as “seizure disorder” or “sleep disorder,” but does not imply that this condition cannot be treated, healed, and overcome. PTSD absolutely CAN be treated just like many other disorders in medicine.
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.
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.
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.
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.
The nerve which is treated by a stellate ganglion block is called the Cervical Sympathetic Trunk (CST) which lies on BOTH sides of your neck and connects your brain to your body with regards to fight or flight signal transmissions. Sometimes an SGB is performed on the right side of the neck; sometimes on the left. Let me explain.
Although SGB has been demonstrated in the medical literature to provide durable relief of anxiety and post-traumatic stress symptoms, 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 SGB therapy, and they fail to respond robustly to a right-sided SGB, then the patient should consider a left-sided SGB. This must be done at least at least 8 hours later for safety reasons. Dr. Lynch will not perform a block on both sides of the neck at the same time due to the risk that could pose for airway compromise.
The vast majority of patients respond well to a right-sided SGB, so that is where Dr. Lynch recommends starting. About 5-10% of patients will not respond to a right-sided SGB but will respond profoundly to a left-sided SGB. This novel effect was noted in clinical practice in 2020 and was published in the literature (see evidence page). This 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.
In 2023 Dr. Lynch and colleagues first demonstrated that treatment with an SGB on the right side followed by an SGB on the left side the next day resulted in superior symptom relief when compared to a right-sided SGB alone. This was a critical finding, so currently we suspect that blocking both sides probably provides greater relief for most people than a single side.
If someone fails to respond to a properly performed SGB (with a good resulting Horner’s Syndrome) on both sides, then it is reasonable to try again in a month as some people with severe, deeply rooted symptoms may not respond to the first treatment or may have only transient benefits.
If repeated SGB does not demonstrate effectiveness in someone, then this should not be considered an effective therapy for this patient.
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. A high level of skill is critical when injecting in the neck since there are many important structures adjacent to the stellate ganglion.
Risks include: pain, bleeding, allergic reaction, damage to surrounding structures, seizure, and the risk of making your symptoms worse. The risk of anxiety or PTSD symptoms worsening for an extended period of time following SGB can be estimated at 0.1% based on expert opinion and experience with over 6,000 SGB procedures.
Many doctors were trained to use fluoroscopy (live x-ray) to perform SGB; however, Dr. Lynch uses ultrasound. Ultrasound-guided SGB is safer, more effective, and does not expose patients to ionizing radiation like fluoroscopy does. Most importantly, though, ultrasound provides incredible visibility of your anatomy, including blood vessels and any anatomic variations, which may go unnoticed with fluoroscopy. Using ultrasound guidance to safely perform an SGB takes additional advanced ultrasound training and considerable skill which many pain medicine-trained physicians do not have.
See attached handout:
No. Sedation likely increases the risk of this procedure. This may sound counterintuitive.
Dr. Lynch has performed over 4000 SGBs over the past 15 years and has never used sedation on any patient. This procedure is NOT painful. Many people do not like needles, but rarely is this a problem since Dr. Lynch does not rush. He will talk you through everything. You will lay comfortably on your back and are encouraged to breathe normally, swallow normally, and you don’t have to hold rigidly still. The whole procedure takes less than 10 minutes.
On the other hand, if you are sedated for an SGB, this requires adding medication that has additional side effects. And while sedated you are not able to communicate to your physician if you have pain or other dangerous sensations that would indicate to the physician that something may be wrong. This is why Dr. Lynch never has needed to sedate his SGB patients.
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. Ultrasound allows you to clearly 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.
Yes, SGB has been used for the past 5 years to treat symptoms that persist after COVID infection. Dr. Lynch has used SGB for this indication since 2021 when the first wave of Long COVID sufferers were seeking helpful treatment options. Most of Dr. Lynch’s patients get some benefit–some see great benefit (improved brain fog, return to normal smell/taste), others see partial benefit. Because Long COVID has only been described in the past 4-5 years, our understanding of this condition and treatment options are still evolving.
Several recent articles support the use of SGB to treat such symptoms as rapid heartrate, brain fog, chronic fatigue, and loss of/abnormal taste (dysgeusia), or loss of/abnormal smell (parosmia). Other conditions which seem to be related to dysfunction in the autonomic nervous system may also improve following SGB treatment such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Postural Orthostatic Tachycardia Syndrome (POTS).
See article by Dr. Lynch on SGB for POTS. Click here.
The published literature on this topic is growing.
For more information, see:
1-Levey AO, Chen GH, Ngyuen A, Ostrosky-Zeichner L, Hasoon J, Saroukhani S, Lin M. The Effectiveness and Safety of Stellate Ganglion Block in the Treatment of Symptoms from Long COVID-19: A Pilot Study. Psychopharmacology Bulletin. 2024 Aug 1;54(4):8-17.
2-Liu LD, Duricka DL. Stellate ganglion block reduces symptoms of Long COVID: A case series. Journal of neuroimmunology. 2022 Jan 15;362:577784.
3-Duricka D, Liu L. Reduction of long COVID symptoms after stellate ganglion block: A retrospective chart review study. Autonomic Neuroscience. 2024 Jun 13:103195. (see chart below)
4-Duricka DL, Liu LD. Stellate Ganglion Block reduces symptoms of SARS-CoV-2-induced ME/CFS: A prospective cohort pilot study. Fatigue: Biomedicine, Health & Behavior. 2025 Feb 4:1-8.
Yes, it appears in preliminary research, that SGB can provide significant improvement in traumatic brain injury (TBI)/concussion symptoms. In 2024, Dr. Lynch and colleagues published the first case series demonstrating a 50% reduction in TBI symptoms following SGB.
Further controlled studies should be conducted to investigate this novel finding. Considering that post-concussive symptoms are debilitating for many people and may not respond to standard treatments, SGB should be viewed as a simple, safe treatment worthy of consideration.
What is the possible mechanism that SGB might help in TBI? 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 in traumatic brain injuries. More studies are underway to explore SGB in TBI treatment.
Stellate Ganglion Block works even if you don’t have a stellate ganglion.
How is this possible?! Because this is just a terminology issue. The diagram in this video will make sense. A picture is worth a thousand words.
Everyone has a cervical sympathetic chain which runs along the neck. When 2 clusters of nerves–called ganglia–are fused together at the C6/C7/T1 levels, then we call that a “Stellate Ganglion.” However, in 20% of people, the inferior cervical and superior thoracic ganglia lie adjacent to each other but are not fused into one, so technically they are not a stellate ganglion. However, when you numb either of these anatomic variations with an anesthetic like we do in a stellate ganglion block procedure, the result is the same.
So, really there is no clinical significance.
Dr. Lynch routinely performs SGB at both the 4th and 6th cervical vertebral levels (C4 and C6) on the same side of the neck 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.
Well, the FDA does not approve procedures, so no!
But, Yes, SGB is an approved, standardized procedure according to the national body who approves the appropriateness and use of medical procedures.
The Food & Drug Administration approves the use of medications and medical devices, but does NOT approve medical procedures. Rather, a procedure may be considered “approved” if it is standard procedure with an approved CPT code as detailed in the CMS National Coverage Policy. The CPT Code for Stellate Ganglion Block is 64510.
SGB has been in use safely for over 100 years, is taught graduate medical education in select specialties, and has been used for a variety of medical indications since the 1920s.
Dr. Lynch has been performing and studying SGB for Anxiety and PTSD for over 15 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.
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.
Everyone is screened prior to being scheduled. No additional appointment is needed for screening.
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.
I recommend that you do not drive for at least 6 hours after this procedure. Please plan to have a driver with you or use a rideshare service. Because your balance may be slightly affected for a few hours, you should also avoid anything that might place you at risk if you were to fall, such as working at heights or riding a bicycle.
Baltimore Washington International Airport (BWI) is the closest airport and is just a 20-minute ride away. Rideshares are readily available.
Reagan International Airport (DCA) is 45 minutes away, but is subject to heavy rush hour traffic, and travel times may be unpredictable.
Dulles International Airport (IAD) is approximately 1 and a half hours away and also subject to heavy traffic.
Our clinic is located at: 2401 Brandermill Blvd, Suite 200, Gambrills, MD 21054
Located at 2401 Brandermill Blvd, Suite 200, Gambrills, MD 21054, Dr. Lynch’s clinic is conveniently located with many amenities within walking distance (restaurants, shops), including hotels that are walking distance away.
Lodging options for Anne Arundel County can be found here.