What is a Stellate Ganglion Block (SGB)?

SGB is an outpatient procedure involving an injection of a local anesthetic near the stellate ganglion, a cluster of nerves in your neck. This 30-45 minute treatment aims to ease symptoms associated with post-traumatic stress injury (PTSI also known as PTSD) and trauma-related mood disorders by offering a reset to your body's stress response system. Read more about the science here.

Understanding the Stellate Ganglion

The stellate ganglion is part of your sympathetic nervous system, responsible for your "fight-or-flight" response. Trauma can cause this system to become overactive, leading to prolonged stress responses that can manifest as depression, anxiety, insomnia, and more. SGB helps by temporarily numbing the stellate ganglion, interrupting this overactivity and allowing your nervous system to reset.

Procedure Overview

 Before Treatment:  Fill out an intake form and have a consultation with Dr. Ko  Next, review and sign the consent form. Continue taking your medications as usual. Plan for someone to drive you home post-treatment.

-  During Treatment:  Relax in a comfortable chair while we administer a local anesthetic to the targeted areas. The procedure uses Butterfly IQ3+ ultrasound guidance with Doppler color flow to ensure accuracy and is completed within 30-45 minutes.

-  After Treatment:  You will be monitored in the clinic for a short time period. Please expect to experience minor, temporary side effects like Horner's syndrome, which include droopy eyelid, redness of the eye on the treated side, & a hoarse voice. These effects indicate the procedure's success and resolve within 4-8 hours. Other effects like nasal congestion, headache, and mild soreness/swelling at the injection site may occur but are easily manageable.

Is SGB Right for You?

While most research on SGB has focused on PTSD/PTSI and chronic pain, it may also benefit those with anxiety & long COVID symptoms. Also, it is best used as an adjunct to psychotherapy, counseling, medications, & lifestyle changes. We encourage you to discuss with our team to determine if SGB is a suitable addition to your treatment plan.

Will I get the right side, left side, or both sides of the neck?

SGB is typically administered on the right initially.

Although SGB can significantly relieve anxiety and PTSD symptoms, it’s not universally effective. If a patient doesn’t respond well to a right-sided SGB, we may consider a left-sided block, at a later time.

Most patients respond well to a right-sided SGB, but about 5-10% who don’t might find a left-sided SGB beneficial. Some research shows that a sequential bilateral SGB—first right, then left side at a later time—provided superior relief compared to a single side.

If a patient doesn’t respond to SGB on both sides, even with proper Horner’s Syndrome induction, retrying after a month may be effective for some. However, if repeated attempts fail, SGB may not be suitable for that patient.

How much does SGB Cost?

Please review this link for the SGB pricing & payment policy information sheet.

Benefits and Safety

SGB has been used for nearly a century, primarily for chronic pain relief, before its benefits for PTSI/PTSD and mood disorders were recognized. Research and patient experiences suggest significant relief from PTSI symptoms, with some finding ongoing benefits from a single treatment. At our clinic, SGB is administered by an emergency physician trained in procedural ultrasound use, ensuring a safe and effective experience.

Who should not get an sGB?

Contraindications for SGB include:

• Recent myocardial infarction (aka heart attack), where the risks due to sympathetic nervous system manipulation might outweigh the benefits.

• Patients who are on anticoagulation therapy (Plavix, Warfarin, etc.) or have a known bleeding disorder, as there is a risk of bleeding.

• Individuals with glaucoma, as changes in blood flow or pressure could potentially exacerbate the condition.

• Those with a pre-existing contralateral nerve palsy, severe emphysema, or cardiac conduction blocks, where the block could worsen symptoms or lead to complications.

Integrating SGB with Ketamine Therapy

SGB can also potentially complement the beneficial effects of ketamine therapy, contributing to a holistic approach to your wellness. This combination may help some achieve mental clarity, improve mood, reduce anxiety, fight-flight-flee symptoms, and enhance overall well-being.

How many Treatments will I need?

About one-third of patients are successfully treated with a single SGB and don't need additional sessions. There is no requirement to repeat the procedure to maintain its benefits. However, some choose to repeat it if their symptoms return due to triggers or stressful periods.

If the first SGB was helpful, it can be safely repeated, with similar effectiveness. Follow-up surveys at one week and one month post-treatment help quantify benefits and determine if another SGB is needed.

Our Commitment

Our goal is to partner with you in finding the most effective treatments for your mental and physical health. SGB offers a promising option for resetting and healing from the impacts of trauma and mood disorders, providing a foundation for further positive changes in your life.