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Stellate Ganglion Block


What is Stellate Ganglion Block?

The stellate ganglion block (SGB) is a procedure in which an injection of a long-acting local anesthetic, using ultrasound guidance, is made in the side of the neck around the main nerve that controls the “fight or flight” response (the sympathetic nervous system). This nerve, (the cervical sympathetic chain) which is a two-way conduit, connects the parts of the brain that control the fight or flight response (referred to as the central autonomic network) to the rest of the body. By blocking or “turning off” the traffic in the cervical sympathetic chain, it is believed that the parts of the brain that control the fight or flight response are allowed to completely reset, resulting in long-term relief of the associated anxiety symptoms. Multiple peer-reviewed medical studies show that SGB results in significant long-term improvement in chronic anxiety symptoms associated with post-traumatic stress injury (PTSI). The SGB takes less than 15 minutes to perform, and benefits are seen in as little as 30 minutes.

(Although the term PTSD is more commonly used, Dr. Lynch feels that the term post traumatic stress injury (PTSI) is medically more accurate. After all, an injury is something you can recover from.)

What is Stellate Ganglion Block?
James H. Lynch, MD - Treating the injury of trauma

What types of trauma is SGB used to treat?

Dr. Lynch has successfully treated trauma from a variety of sources, including but not limited to:

  • Sexual abuse or assault
  • Domestic/Intimate Partner Violence (IPV)
  • Childhood abuse or neglect
  • First responder related trauma
  • Combat-related
  • Life-threatening events (accidents, illnesses)
  • Medical trauma
  • Complex PTSD (CPTSD)

What does SGB treat?

SGB has been used since the 1920s to treat a variety of conditions, primarily pain related.  Since 2011, in clinical practice and research, Dr. Lynch has extensively utilized SGB to treat symptoms of anxiety and posttraumatic stress.  He has also used SGB to successfully treat other anxiety conditions, Long COVID—including abnormal taste and smell problems (parosmia and dysgeusia), vasomotor symptoms associated with menopausal hot flashes, as well as helping to reduce symptoms during treatment for substance addiction.

How does SGB work to reduce Anxiety and PTSD symptoms?

The stellate ganglion is part of the cervical sympathetic trunk (CST), a key part of the sympathetic nervous system (the “fight or flight” nervous system.) For many people, stressful or traumatic experiences cause the “fight or flight” nervous system to get stuck in an elevated or hyperaroused state. 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. This allows neurotransmitters in the brain to “reset” back to a non-anxiety state. After about 6-8 hours, the ropivacaine wears off, and this “resetting” results in the restoration of a normal sympathetic tone. SGB typically provides immediate and long-term relief of anxiety symptoms by improving sleep, concentration, irritability, hyperarousal, and mood.

What research is available on SGB for Anxiety and PTSD?

Peer-reviewed medical studies on SGB can be found here.

James Lynch, MD - Stellate Ganglion Block
Ultrasound guidance SGB

Ultrasound vs. fluoroscopic SGB

Dr. Lynch performs all SGBs under real-time ultrasound guidance.

Ultrasound allows a very small needle (25 gauge) to be safely guided around the nerves and blood vessels in the neck as it is placed next to the stellate ganglion and cervical sympathetic trunk (CST).  In contrast, under x-ray (fluoroscopic) guidance, only bones are visible, and since blood vessels and nerves are not visible, the position of the nerves can only be approximated.  Blood vessels may be inadvertently punctured using fluoroscopy, but they are clearly visible in color under ultrasound.  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.

100% of the physicians that Dr. Lynch has worked with who are trained in both ultrasound AND fluoroscopy, have switched over to exclusively using ultrasound to perform SGB.  Many, many other physicians in Europe, Canada, and the US still use fluoroscopy because that is how they were trained.

Gold Standard Evidence Supporting SGB

Since 2010, many US military treatment facilities have used Stellate Ganglion Block effectively to help thousands of service members suffering from symptoms associated with PTSD. ​This has been an effort to help keep warriors on combat teams at top performance—to hone the edge of a knife that has dulled with hard use.

There are over 20 original studies published since 2008 in the peer-reviewed medical literature documenting SGB’s successful treatment of PTSD symptoms.  In November 2019, a large multi-center, randomized clinical trial was published in JAMA Psychiatry demonstrating twice the effect of SGB over a sham (placebo) procedure.  Now with “gold standard” Level 1 evidence supporting SGB, many clinicians believe this procedure should be incorporated into standard PTSD care.

These early lessons learned from treating military members can be readily applied to our first responder communities who experience many of the same challenges in the law enforcement, firefighter, and emergency medical services professions.  Additionally, SGB has been integral to help these cultures reduce the stigma of seeking help and opening the door to effective mental health.

Gold Standard Evidence Supporting SGB