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)
- Dysautonomia
- 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)
- Tinnitus
- Sudden Deafness
- Migraine
- Excessive Daytime Sleepiness
- Hot Flashes
- TBI
Stellate Ganglion Block Pricing*
| Covered Service Fee | Non-Covered Service Fee | Late Cancellation Fee (Within 48 hours of Visit) |
|
| SGB Injection, two segments, under Ultrasound Guidance
Nurse Visit with Vagus Block/Hydrodissection/Stimulation |
$276
$41
|
$655
$200 |
$150**
|
**$150 late cancellation fee also applies to Initial Consultation Visit
Please note that the above pricing is per injection. It may take 2 to 4 SGB visits for complete treatment protocol depending on conditions being treated.
*Stellate Ganglion Blocks for conditions other than select pain syndromes at a single level are currently considered experimental procedures by major insurance companies and incur a charge of $655. AIMS can directly bill contracted insurance companies for standard management and coordination of care before and after procedure ($276) and for nurse safety check visit ($41). If we are not going through insurance, the total cost would be $276 + $41 + $655 = $972. If SGB includes ketamine prescribed and administered by appropriately licensed clinicians, an additional $52 charge will be added. If insurance coverage is available for a single-level SGB, additional segments under ultrasound guidance will be charged at $200.
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.
SGB Resources
Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms A Randomized Clinical Trial
JAMA Psychiatry | Original Investigation
November 2019
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.
Analgesic efficacy of stellate ganglion block in head and neck cancer pain: A case series
J Family Med Prim Care| 024 Mar;13(3):1111-1114. doi: 10.4103/jfmpc.jfmpc_1190_23. Epub 2024 Apr 4.
Stellate ganglion block to mitigate thalamic pain syndrome of an oncological origin
Pain Practice. 24 July 2023 doi: 10.1111/papr.13275.
Stellate Ganglion Block for Complex Regional Pain Syndrome Treatment After SARS-CoV-2 Vaccine: A Case Report
Cureus. 2023 Apr; 15(4): e38318
Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study
Headache: The Journal of Head and Face Pain | 2023 Jun;63(6):763-770. doi: 10.1111/head.14537. Epub 2023 Jun 14.
Stellate Ganglion Block for Intractable Hiccups Secondary to a Motor Vehicle Collision
Cureus. 2023 Apr; 15(4): e37030.
A case of severe trigeminal neuralgia: recovery by means of stellate ganglion block with procaine. Discussion of possible mechanisms of action
Journal of International Medical Research | 2023 Apr; 51(4): 03000605231164479.
Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients
Journal of Personalized Medicine | 2023, 13(6), 958; https://doi.org/10.3390/jpm13060958
Combining a stellate ganglion block with prolonged exposure therapy for posttraumatic stress disorder: A nonrandomized clinical trial
Journal of Traumatic Stress | 2022 Sep 1. doi: 10.1002/jts.22873. Epub ahead of print.
Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study
Cureus. 2023 Sep; 15(9): e45161.
Short Communication: Stellate Ganglion Blockade for Persistent Olfactory and Gustatory Symptoms Post-COVID-19
Local and Regional Anesthesia 2023:162
Stellate ganglion block reduces symptoms of Long COVID: A case series
Journal of Neuroimmunology | Short Communication | Vol 362, 577784, JANUARY 15, 2022
Stellate ganglion block for anosmia and dysgeusia due to long COVID
Cureus 14(8): e27779. doi:10.7759/cureus.27779237
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.
Stellate ganglion block rectifies excessive daytime sleepiness: a case report
Journal of International Medical Research (2022) 50:8:1-5.
Effects of stellate ganglion block on perimenopausal hot flashes: a randomized controlled trial
Frontiers in Endocrinology (2023) 14:1293358.
Stellate ganglion block with procaine in breast cancer survivors with hot flashes and sleep disturbances undergoing Endocrine Therapy
Medicine (Baltimore) (2024) 103(2): e36848.
Prospective study on ultrasound-guided stellate ganglion block improves cerebral blood flow in patients with stroke
Journal of Stroke and Cerebrovascular Diseases (2024) 33(4):107593.
