Stellate Ganglion Block
Dr. Forest Dobbs is performing the stellate ganglion block (SGB) procedure for the treatment of post-traumatic stress disorder and other conditions related to trauma, chronic pain and chronic stress. This a 15 min procedure that involves injection under ultrasound guidance of a long-acting local anesthetic at the base of the neck. Benefits are seen in as little as 30 minutes.
How does it work?
The anesthetic bathes the stellate ganglion in the cervical sympathetic chain, the main bundle of nerves that controls the “fight or flight” response (the sympathetic nervous system), which is overactivated in PTSD and chronic pain. By temporarily blocking signaling in the cervical sympathetic chain, it is believed that amygdala and other brain centers involved in the fight or flight response are allowed to completely reset, resulting in long-term relief of the associated anxiety symptoms. Patients report minimal to no discomfort with the procedure. It is generally repeated twice over a two-week period and can be repeated as needed. Outcomes are tracked with the PCL-5 checklist instrument which can be viewed here.
Beyond PTSD and pain
SGB can potentially treat these additional conditions based on emerging evidence listed below:
- Long COVID symptoms (include fatigue, brain fog, anosmia, dysgeusia, orthostatic intolerance, cough)
- POTS (Postural orthostatic tachycardia syndrome)
- Chronic fatigue syndrome (ME/CFS)
- Dysgeusia (perception of taste is altered; everything seems sweet, sour, bitter, or metallic)
- Ageusia (loss of taste)
- Parosmia (Inability to properly identify an odor’s “natural” smell)
- Anosmia (loss of smell)
- Sudden Deafness
Stellate Ganglion Block Pricing*
|Covered Service Fee||Non-Covered Service Fee||Late Cancellation Fee
(Within 48 hours of Visit)
|SGB Injection under Ultrasound Guidance||$240||$655||$150|
*Stellate Ganglion Block for conditions other than select pain syndrome is currently considered an experimental procedure by major insurance companies. AIMS can directly bill contracted insurance companies for the management and coordination of care before and after procedure and for nurse safety check visit ($35 if direct pay). If SGB includes ketamine prescribed and administered by appropriately licensed clinicians, an additional $45 charge will be added.
Right Sided Stellate Ganglion Block injection under Ultrasound Guidance performed by Dr. Dobbs. Needle tip is visible in the upper left portion of the video screen. Blood flow in the internal jugular vein is in blue and in the internal carotid artery is red.
Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms A Randomized Clinical Trial
JAMA Psychiatry | Original Investigation
Kristine L. Rae Olmsted, MSPH; Michael Bartoszek, MD; Sean Mulvaney, MD; et al.
CONCLUSIONS AND RELEVANCE In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild- moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct.
60 minutes: SGB: A possible breakthrough treatment for PTSD – 14 minute news clip that aired November 2019 on 60 Minutes. It is shows footage of the Stellate Ganglion Block up close and personally from providers’ and patients’s perspectives in real time.
Dr. Sean Mulvany’s website on the SGB for PTSD – For further information and references.
Stellate ganglion block reduces symptoms of Long COVID: A case series
Journal of Neuroimmunology | Short Communication | Vol 362, 577784, JANUARY 15, 2022
Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19
Autonomic Neuroscience: Basic and Clinical 237 (2022) 102903
Long-term results of stellate ganglion block in patients with olfactory dysfunction.
The Korean journal of pain, 2013 Jan, 26(1), 57–61.
Effect of stellate ganglion injections guided by different approaches on hearing threshold in patients with sudden deafness
American Journal of Otolaryngology–Head and Neck Medicine and Surgery, 2021 Sep 10;43(3):103201.
Real-time ultrasound-guided stellate ganglion block for migraine: an observational study
BMC Anesthesiology (2022) 22:78.