Advanced & Specialized Procedures
Advanced image-guided options for selected chronic or complex pain conditions when standard therapies have not provided enough relief.
View pageStellate Ganglion Block (SGB)
A stellate ganglion block places local anesthetic near a nerve cluster in the neck to temporarily reduce sympathetic nerve activity.
Overview
An ultrasound-guided injection of local anesthetic near a nerve cluster in the neck, used to temporarily reduce sympathetic nerve activity.
Symptoms and conditions it may help
The stellate ganglion block is most often considered for patients with symptoms driven by sympathetic nervous system overactivation. By temporarily reducing that activity, some patients experience significant relief in hyperarousal, anxiety, and PTSD-related symptoms - often quickly enough to improve engagement with other therapies.
- Post-traumatic stress disorder (PTSD)
- Complex regional pain syndrome (CRPS)
- Hyperarousal
- Anxiety
- The intended result is often a reduction in hyperarousal and anxiety so the patient can better engage with other treatments such as psychotherapy and medication
Expected benefits and treatment role
- Reduction in PTSD symptoms
- Reduction in CRPS symptoms
- Rapid onset of symptom relief in some patients
- Potentially improved outcomes when combined with treatments such as psychotherapy
Stellate ganglion anatomy
A specialized block targets sympathetic nerve activity in the neck.
Evidence and off-label use
- Clinical evidence has reported meaningful symptom improvement in selected patients
- Clinical trials, including Olmsted et al., 2019, are cited as showing meaningful improvement in PTSD symptoms
- Published outcomes and clinic materials describe positive responses in many treated patients
- This is considered an off-label treatment in this setting
Off-label context
The use of stellate ganglion block for PTSD and related conditions is considered off-label. Patients should discuss the available evidence, realistic expectations, and the role this treatment plays within a broader care plan before proceeding.
Temporary effects and rare risks
- Temporary Horner's syndrome with a droopy eyelid, constricted pupil, and red eye
- Hoarseness
- A lump-in-the-throat sensation
- Pain or redness at the injection site
- Temporary difficulty swallowing or speaking
- Rare side effects can include breathing changes, neck pain, hematoma, seizure from inadvertent intravascular uptake, or pneumothorax
Aftercare and restrictions
- Patients are monitored for 30 minutes after the procedure
- Avoid driving for 24 hours
- Have a support person present
- Use ice on the injection site if needed
- Avoid warm drinks until normal sensation returns
- Resume eating and drinking when the voice returns to normal
Contraindications and alternatives
Patients with a known allergy to local anesthetics such as bupivacaine or Sensorcaine should not proceed with this procedure. Other contraindications and safety considerations will be reviewed individually by the treating physician.
Alternative treatments for PTSD and related conditions include psychotherapy, pharmacological options such as SSRIs, and other evidence-based interventions. This block is typically part of a broader care plan rather than a standalone treatment.
When to seek immediate medical attention
- Severe neck pain
- Difficulty breathing
- Persistent side effects that do not resolve as expected
Next Step
Discuss whether stellate ganglion block is appropriate.
The clinic can review your symptoms, prior treatment, imaging, and whether this procedure fits into your care plan.
If you have a question after a recent procedure, call the clinic directly rather than waiting for an online response.