What is Stellate Ganglion Block?

The stellate ganglion block (SGB) is a procedure in which an injection of a long-acting local anesthetic, using ultrasound guidance, is made in the side of the neck around the main nerve that controls the “fight or flight” response (the sympathetic nervous system). This nerve, (the cervical sympathetic chain) which is a two-way conduit, connects the parts of the brain that control the fight or flight response (referred to as the central autonomic network) to the rest of the body. By blocking or “turning off” the traffic in the cervical sympathetic chain, it is believed that the parts of the brain that control the fight or flight response are allowed to completely reset, resulting in long-term relief of the associated anxiety symptoms. Multiple peer-reviewed medical studies show that SGB results in significant long-term improvement in chronic anxiety symptoms associated with post-traumatic stress injury (PTSI). The SGB takes less than 15 minutes to perform, and benefits are seen in as little as 30 minutes.

(Although the term PTSD is more commonly used, Dr. Mulvaney feels that the term post traumatic stress injury (PTSI) is medically more accurate. After all, an injury is something you can recover from.)

SGB Overview

What does SGB treat?

In clinical practice and research, Dr. Mulvaney has extensively practiced and published on the use of SGB to treat the anxiety symptoms associated with PTSI. They have also used SGB to successfully treat other anxiety conditions, vasomotor symptoms associated with menopausal hot flashes, as well as helping reduce symptoms during treatment for substance addiction.

SGB is not a treatment for depression, bipolar disorder, schizophrenia or any variants of schizophrenia, personality disorders or seizure disorders.

How does SGB work to help PTSD symptoms?

The stellate ganglion is part of the cervical sympathetic chain, a key part of the sympathetic nervous system (the “fight or flight” nervous system.) In PTSI and some other anxiety conditions, the “fight or flight” nervous system gets stuck in the “ON” position. By precisely placing long-acting local anesthetic (ropivacaine) around the stellate ganglion, the unproductive and chronic “fight or flight” response is turned off for several hours. This allows neurotransmitters in the brain to “reset” back to a non-anxiety state. This “resetting” results in long-term relief of anxiety symptoms. The SGB may improve daily activities, sleep, relationships, mood, employment and more.

What research is available on SGB for PTSD?

A list of peer reviewed medical studies on SGB can be found here.

Ultrasound vs. fluoroscopic SGB

Dr. Mulvaney performs all SGBs under real-time ultrasound guidance.

Ultrasound allows the needle to be safely guided around the nerves and blood vessels in the neck as it is placed next to the stellate ganglion. Under x-ray (fluoroscopic) guidance, only bones are visible, and nerves are not visible at all, therefore position of the nerves can only be approximated. Using ultrasound guidance to safely perform an SGB takes special additional training and considerable skill which many pain medicine trained physicians do not have.

During his fellowship in anesthesia/pain medicine at Walter Reed National Military Medical Center, Dr. Mulvaney learned to do SGBs with fluoroscopic-guidance. He rejected this method, as compared to ultrasound-guided SGB, as it was more painful, less efficacious and exposed patients to ionizing radiation from the x-ray.

Gold Standard Evidence Supporting SGB

Since 2010, several US military treatment facilities have used Stellate Ganglion Block effectively to help thousands of service members suffering from symptoms associated with PTSD.

​This has been an effort to help keep warriors on combat teams at top performance—to hone the edge of a knife that has dulled with hard use.

There are 15 original studies published since 2008 in the peer-reviewed medical literature documenting SGB’s successful treatment of PTSD symptoms.  In November 2019, a large multi-center, randomized clinical trial was published in JAMA Psychiatry demonstrating twice the effect of SGB over a sham (placebo) procedure.  Now with “gold standard” Level 1 evidence supporting SGB, many clinicians believe this procedure should be incorporated into standard PTSD care.