Frequently Asked Questions
Detailed answers about the SGB procedure, eligibility, risks, outcomes, and scheduling — from Dr. Mulvaney's 25+ years of clinical experience.
About the Procedure
1.How much experience does Dr. Mulvaney have with SGB?+
Dr. Mulvaney has published more original research on SGB for PTSD than any other scientist globally. He has published over 18 publications in the peer-reviewed medical literature on this topic. He has been performing and studying SGB since 2009, completing over 5,200 ultrasound-guided procedures — making him one of the most experienced SGB physicians in the world. He has appeared on CBS 60 Minutes and has taught hundreds of physicians neck anatomy and SGB methodology across national and international lectures.
2.How does SGB work to treat PTSD symptoms?+
The Stellate Ganglion is part of the cervical sympathetic chain — the "fight or flight" nervous system. In PTSD, this system becomes locked in the ON position. Ultrasound-guided placement of long-acting local anesthetic (ropivacaine) around the stellate ganglion temporarily disengages this chronic response, allowing the brain and body to reset to a non-anxious baseline. The brain's natural neuroplasticity then enables durable, long-lasting change.
3.At what level does Dr. Mulvaney perform the SGB?+
Dr. Mulvaney performs SGB at two levels: C6 and C4. Following his June 2020 publication — and multiple studies published since — demonstrating that two-level blocks provide greater benefit than single-level, injections at both C6 and C4 are now standard practice at no additional cost. For the full published research, visit our Evidence page.
4.Why is ultrasound guidance better than fluoroscopic or X-ray guidance?+
In skilled hands, ultrasound enables clear visualization of the needle, nerves, and blood vessels — in addition to the bony landmarks — adding a significant level of both safety and comfort to the procedure. Fluoroscopic or X-ray guidance can only see bones. Fluoroscopic guidance uses bony landmarks to approximate where the stellate ganglion is, whereas with ultrasound guidance, we can not only avoid other nerves but target the stellate ganglion specifically. Dr. Mulvaney trained in fluoroscopic-guided SGB during his Walter Reed fellowship but rejected it as more painful, less effective, and unnecessarily risky.
5.How does Dr. Mulvaney verify the procedure was successful?+
Dr. Mulvaney first published a grading scale for evaluating Horner's syndrome — the expected temporary changes following a successful SGB on the blocked side. These include ptosis (eyelid drooping), miosis (pupil reduction), and scleral redness. A staff member grades the Horner's response to reduce bias. If the response is inadequate at 5 minutes, the injection is immediately repeated on the same side. After treatment is completed, we send monthly follow-up surveys — PCL-5, GAD-7, or NSI as appropriate — by fillable email to objectively track your results over time.
6.Do I need to be sedated?+
No. Sedation significantly increases procedural risk. Dr. Mulvaney has performed over 5,000 SGBs without sedation. The procedure is not painful — most patients rate it 1/10 for discomfort. The calm clinic environment and thorough explanation help even needle-averse patients proceed successfully.
7.Is the SGB uncomfortable?+
Most people report a discomfort level of less than 1 out of 10 during the procedure. The SGB is performed in a calm, relaxed setting, and we numb the skin thoroughly beforehand — so the vast majority of patients are pleasantly surprised by how manageable it is.
Conditions Treated
8.What is PTSD?+
PTSD (Post-Traumatic Stress Disorder) is a psychiatric disorder that can affect anyone who has experienced or witnessed a traumatic event — not just military personnel. Causes include sexual violence, childhood abuse, domestic violence, accidents, natural disasters, terrorism, first responder trauma, and many other life events. Some prefer the term "Post-Traumatic Stress Injury" to reduce stigma and reflect its biological nature. Common symptoms include irritability, startling easily, angry outbursts, concentration and sleep problems, distressing dreams or involuntary memories, and emotional detachment. PTSD affects approximately 3.5% of U.S. adults annually; one in 11 people will receive a diagnosis in their lifetime.
9.What PTSD Symptoms Does SGB Help With?+
SGB is most effective for hyperarousal symptoms driven by the sympathetic nervous system — including irritability, angry outbursts, poor sleep, racing heart, sweating, and increased muscle tone. Physical re-experiencing symptoms also improve substantially. SGB is not specific treatment for Autism, Bipolar disorder, Schizophrenia, Personality Disorders, or Seizure disorders, though individuals with these conditions may also have PTSD, in which case SGB may still be helpful.
10.Can SGB treat anxiety, even without a PTSD diagnosis?+
Yes. SGB effectively treats anxiety symptoms more broadly. A 2023 study of 285 patients achieved a 50% reduction in anxiety symptom scores — exceeding twice the clinically important threshold. Bilateral blocks were found to be more effective than single-sided procedures. This was the first study to demonstrate that sequential bilateral SGB provided superior relief compared to unilateral treatment. A 2025 study published in Brain Sciences further confirmed these benefits, demonstrating three-month durability of bilateral two-level SGB in patients with Generalized Anxiety Disorder — showing that improvements in anxiety symptoms were maintained at the three-month follow-up.
11.Can SGB treat long COVID or other post-viral syndromes?+
Emerging evidence suggests SGB may be an effective treatment for long COVID symptoms. The autonomic nervous system (ANS) plays a crucial role in managing acute hyperinflammation and endothelial dysfunction, and marked sympathetic hyperactivity is well-documented during and after COVID-19 infection. By resetting the sympathetic nervous system, SGB may relieve the persistent, dysregulated ANS response underlying many long COVID symptoms.
A 2023 retrospective cohort study by Pearson et al. of 41 patients (age 18–89, symptoms lasting 3–29 months) found that SGB relieved long COVID symptoms in 86% of patients. Patients received unilateral or bilateral SGB. The following symptoms showed the highest rates of relief among those who had each symptom:
| Symptom | Had symptom | Got relief |
|---|---|---|
| Pins and needles sensation | 22% | 100% |
| Rash | 5% | 100% |
| Joint and muscle pain | 39% | 94% |
| Diarrhea | 20% | 88% |
| Shortness of breath | 41% | 88% |
| Cough | 24% | 80% |
| Chest pain | 24% | 80% |
| Brain fog | 80% | 79% |
| Tachycardia or palpitations | 22% | 78% |
| Fatigue | 85% | 77% |
| Dizziness | 41% | 77% |
| Mood changes | 39% | 76% |
| Post-exertional malaise | 66% | 74% |
| Sleep issues | 34% | 71% |
| Change in taste or smell | 44% | 40% |
Source: Pearson L, et al. "SGB relieves long COVID-19 symptoms in 86% of patients: A Retrospective Cohort Study." September 2023. For the full published evidence, visit our Evidence page.
12.Does SGB help with Traumatic Brain Injury (TBI)?+
Yes — and the evidence base has grown substantially. Dr. Mulvaney has now published three peer-reviewed studies specifically on bilateral two-level SGB for TBI, with consistently strong results across independent patient cohorts.
- •Initial study (Military Medicine, 2024, n=23): NSI scores improved ~53% at one week. 22 of 23 patients showed meaningful symptom reduction after bilateral SGB at C6 and C4.
- •TBI effect independent of PTSD (Brain Sciences, 2024, n=20): Dr. Mulvaney isolated TBI-specific symptoms by removing all items that overlap with PTSD or anxiety from the NSI. Even on this conservative sub-score, patients showed ~50% improvement at one week and one month — the first study to confirm SGB benefits TBI regardless of whether comorbid PTSD is present.
- •3-month durability (Biomedicines, 2025, n=41): 85.4% of patients improved, with an average 48.4% decrease in NSI scores from baseline. Critically, those gains held at the 3-month follow-up, establishing durable benefit. No significant difference between male and female patients.
Taken together, these studies indicate that bilateral two-level SGB produces rapid, meaningful, and durable TBI symptom relief in the large majority of patients — independent of any PTSD co-diagnosis. All TBI patients complete the Neurobehavioral Symptom Inventory (NSI) as a baseline before treatment, with monthly follow-up surveys sent by email to track outcomes objectively over time.
13.Can SGB help with gut or autoimmune issues?+
The SGB Treatment Center routinely performs stellate ganglion blocks, as well as vagus nerve blocks, which have emerging evidence showing that they may be effective for these conditions.
14.Does SGB treat restless leg syndrome?+
We have anecdotal evidence suggesting SGB can be highly effective in relieving the symptoms of restless leg syndrome. While controlled clinical trials are not yet available, patient-reported outcomes have been encouraging. If you suffer from restless leg syndrome, we encourage you to contact our office to discuss whether SGB may be appropriate for you.
15.Does the SGB Treatment Center perform SGBs for pain purposes?+
No. Although SGBs are used for many pain conditions, including Complex Regional Pain Syndrome (CRPS), the SGB Treatment Center does not generally perform SGBs for those purposes. SGBs for standard pain conditions are generally available from any standard pain practice. Since the SGB Treatment Center is not a pain management practice, these patients are better treated where they can receive SGB as part of a coordinated plan for their pain condition.
16.Does Dr. Mulvaney perform vagus nerve blocks?+
Yes. Dr. Mulvaney performs vagus nerve blocks. While much of the evidence remains anecdotal, vagus nerve blocks are showing real promise in the treatment of autoimmune, digestive, and rheumatologic conditions. These procedures are scheduled the same as SGBs. If you have one of these conditions and are interested in learning more, please contact our office.
Results & Safety
17.What is the success rate?+
Properly screened patients demonstrate published success rates exceeding 85%, defined by significant improvements in PCL-5, GAD-7, or NSI scores.
18.What are the risks of the SGB procedure?+
Risk of significant adverse events is minimal — less than 1 in 2,000 — when performed by a skilled ultrasound-guided provider. Minor risks include seizure from inadvertent anesthetic injection into a blood vessel, and an extremely small hematoma risk. Patients on blood-thinning medications should not undergo SGB. Approximately 20% of patients experience temporary hoarseness from anesthetic spreading to the laryngeal nerve — this resolves within one to six hours and is considered a normal occurrence from the spreading of the local anesthetic used, not a procedural error.
19.What if the first SGB doesn't provide the results I hoped for?+
If the right-sided SGB does not provide adequate relief, left-sided SGB may be performed a minimum of one day later. Approximately 1–5% of patients fail to respond to right-sided SGB but respond profoundly to left-sided treatment. Dr. Mulvaney's 2020 research suggests roughly 20% may experience a more profound left-sided response even with partial right-sided improvement. Patients who fail to respond to a properly performed bilateral SGB should talk to their doctor about whether further procedures should be attempted.
20.How many treatments are usually needed?+
Approximately one-third of patients achieve success with a single pair of SGBs. Some experience re-triggering events that necessitate future treatment. The procedure can be safely repeated if the initial treatment was beneficial. We will continue to follow your results by sending the appropriate monthly screening survey — PCL-5, GAD-7, or NSI depending on your condition — to track your progress over time.
Preparing for Your Visit
21.Do I need to stop my medications?+
If you are routinely taking medications for a behavioral health diagnosis, we request that you keep taking them as prescribed. If you are taking a benzodiazepine only as needed for anxiety, we recommend holding that non-routine dose on the day of the procedure so you can better feel what is happening. If you are taking anticoagulation or blood-thinning medicines, we ask you to consult with the prescribing physician about whether it is safe to come off those medicines for this procedure. Please contact our staff if you are unable to come off of these medications. All other medicines may be continued as prescribed.
22.Will using cannabis products like THC gummies or smoking marijuana interfere with my results?+
Although overuse of any substance is generally counterproductive for behavioral health and your general health, the moderate use of THC products does not appear to interfere with our results.
23.Does drinking alcoholic beverages interfere with the SGB?+
The short answer is yes — you should refrain from alcohol for at least the day after having an SGB. SGB can help restore normal sleep patterns, including deep sleep. While alcohol may help some people fall asleep, it prevents the brain from entering the deep sleep stages where it performs critical maintenance. This process is carried out by the glymphatic system — a brain-wide clearing mechanism that removes metabolic waste and supports neurological health. The routine use of alcohol or benzodiazepines prevents the brain from reaching this restorative state and may contribute to anxiety.
24.Are there any dietary restrictions before having an SGB?+
There are no dietary restrictions the night before your SGB. If one or two cups of coffee are part of your normal morning routine, you may have them on the day of the procedure. Otherwise, we ask that you eat only lightly in the four hours before your appointment.
25.Can I drive after the procedure?+
No. Medical standard practice prohibits driving for 6 hours post-procedure. Arrange for a driver or rideshare service.
26.Do I need a referral from a provider or a therapist to get an SGB?+
No referral is needed, although we do encourage people to have an ongoing relationship with a behavioral health provider if they are having ongoing issues.
Scheduling & Logistics
27.Are screening and treatment done in the same appointment?+
There is no pre-screening appointment needed. When you call to make an appointment, SGB Treatment Center will ask you to fill out some simple screening forms. We would like to track your results over time, so we will contact you post-procedure for feedback.
28.What does SGB cost?+
Most insurance plans do not cover SGB for PTSD, TBI, or anxiety, so payment is out of pocket. Right side SGB: $1,300. Left side SGB: $900. Two-day bilateral package: $2,200. Veteran and first responder pricing is available.
29.What airports and hotels are closest to the clinic?+
Baltimore Washington International (BWI) is 25 minutes north. Reagan International (DCA) is approximately 50 minutes away. Dulles International (IAD) is approximately 90 minutes, subject to traffic.
For hotels, the center can provide lodging recommendations via Visit Annapolis.
Still Have Questions?
Call our Annapolis office Monday through Friday, 8 AM to 5 PM.