Stellate ganglion block (SGB) is a medical procedure that involves injecting anesthetic medication into the stellate ganglion, a group of nerves located in the neck. The purpose of the injection is to block the sympathetic nervous system, which can reduce symptoms of conditions such as post-traumatic stress disorder (PTSD), anxiety disorders, and chronic pain.
In this article, we will explore the details of SGB treatment, including its history, how it works, the conditions it is used to treat, the procedure itself, and its potential benefits and risks.
Understanding SGB Treatment
Definition & Overview
SGB treatment involves injecting medication into the stellate ganglion, which is a bundle of nerves that controls autonomic functions of the upper body. Providers use a long-acting anesthetic medication – most commonly Ropivacaine or Bupivacaine.
The purpose of the injection is to block or interrupt the signals sent via the sympathetic nervous system, which can relieve symptoms associated with a variety of conditions including PTSD, anxiety disorders, and chronic pain, and loss of smell from long-covid.
After a person experienced psychological trauma, their nervous system can become dysregulated, leading to symptoms such as anxiety, hypervigilance, and flashbacks. SGB can help to reset the nervous system and reduce these symptoms, allowing the person to function more effectively in their daily life.
The 100-Year History Of Stellate Ganglion Blocks
SGB treatment has a long and interesting history. It was first used in the 1920s to treat circulatory disorders, such as Raynaud’s disease. Doctors found that injecting medication into the stellate ganglion could help to improve blood flow to the affected area, reducing pain and other symptoms.
Over time, doctors began to explore the use of SGB treatment for other conditions. In the 1940s, it was used to treat pain associated with shingles, and in the 1950s, it was used to treat anxiety and depression. Today, Stellate Ganglion Block is an established medical procedure and is used by doctors around the world to treat a range of conditions.
While early doctors used the ‘landmark technique’ to estimate the location of the Stellate Ganglion, today we use accurate ultrasound machines to know location of the injection to within millimeters and insure the utmost safety for patients.
How SGB Works
SGB works by interrupting the signals that are sent via the sympathetic nervous system, which controls many of the involuntary functions of the body. When a person experiences trauma, their nervous system can become dysregulated, and actual physical changes to the nervous system can be seen on brain scans, such as over-activation of the amygdala. leading to symptoms of PTSD such as anxiety, hypervigilance, and flashbacks. Other PTSD symptoms can include irritability, angry outbursts, feeling distant or cut off from others, and difficulty concentrating.
During the procedure, the patient will typically lie on their back with their head turned to the side. The doctor will locate the stellate ganglion using ultrasound or x-ray imaging, and then inject the medication into the area. The procedure usually takes less than 30 minutes, and the patient can usually go home the same day.
Stellate Ganglion blocks may work as therapy-catalyst, helping people get more out of their trauma-focused therapy sessions.
While SGB treatment can be very effective for some people, it is not a cure-all and may not work for everyone. It is important to work closely with your doctor to determine if SGB treatment is right for you, and to explore other treatment options if necessary.
Conditions Treated With SGB
Post-Traumatic Stress Disorder (PTSD)
PTSD is a mental health condition that can develop after a person experiences or witnesses a traumatic event. Symptoms of PTSD can include flashbacks, nightmares, and severe anxiety. SGB treatment has been found to be effective in reducing symptoms of PTSD, and it is often used in combination with other therapies, such as cognitive behavioral therapy.
Studies have shown that SGB treatment can help to reduce the hyperarousal symptoms of PTSD, such as increased heart rate and sweating, as well as improve overall mood and quality of life. This treatment has been studied widely in the veteran population but it is effective with all types of trauma in people of all backgrounds. It is not only limited to combat-related trauma.
Anxiety disorders are a group of mental health conditions that can cause significant distress and impairment. Symptoms of anxiety disorders can include excessive worry, nervousness, and fear. SGB treatment has been found to be effective in reducing symptoms of anxiety disorders, and it is often used in combination with other therapies, such as medication and therapy.
SGB treatment works by blocking the sympathetic nervous system, which is responsible for the “fight or flight” response. By reducing the activity of this system, SGB can help to reduce feelings of anxiety and promote relaxation. This treatment has been particularly effective in patients with social anxiety disorder and panic disorder.
Chronic Pain Conditions
Chronic pain conditions can be caused by a range of factors and can be difficult to treat. SGB treatment has been found to be effective in reducing symptoms of chronic pain conditions, particularly those affecting the head, neck, and upper body. It is often used as a complementary therapy alongside other treatments, such as physical therapy and medication.
SGB treatment works by blocking the sympathetic nervous system, which can reduce pain and inflammation in the affected area. This treatment has been particularly effective in patients with complex regional pain syndrome (CRPS), a chronic pain condition that affects the limbs.
Other Potential Applications
While SGB treatment is most commonly used to treat PTSD, anxiety disorders, and chronic pain conditions, it may also have potential applications in other areas, such as hyperhydrosis, hot-flashes, and anosmia from long-covid. However research is limited in many of these applications.
The SGB Treatment Procedure
Preparing For The Procedure
Before the SGB treatment procedure, the patient will undergo a medical evaluation to ensure that they are a suitable candidate for the treatment. The doctor will also discuss the risks and benefits of the procedure with the patient and answer any questions they may have. Patients may be advised to avoid eating or drinking for a certain period of time before the procedure.
The Injection Process
The SGB injection is typically performed with the patient lying down on their back. The area around the injection site will be cleaned and numbed with a local anesthetic. The physician will then use ultrasound to identify the important structures in the area, then a thin needle is advanced just above the stellate ganglion. At Edelica, we typically perform a second injection a few centimeters above the first one, higher in the sympathetic chain, near the superior cervical ganglion because studies are beginning to show an additional benefit from the second injection. The entire procedure takes less than a half-hour. Patients are observed for a brief period of time, then sent home with a driver.
Post-Procedure Care & Recovery
After the injection, the patient will be monitored for any adverse reactions. They may experience some temporary side effects, such as a sore throat, hoarseness, and drooping eyelids. These side effects typically resolve within a few hours or days. Patients may be advised to avoid strenuous activity for a period of time after the procedure.
Benefits & Risks Of SGB Treatment
The potential benefits of SGB treatment include a reduction in symptoms associated with PTSD, anxiety disorders, and chronic pain conditions. It is a minimally invasive procedure and can be performed on an outpatient basis. SGB treatment may also be less expensive than other treatments for these conditions.
Possible Side Effects & Risks
As with any medical procedure, SGB treatment carries some risks. Possible side effects include pain at the injection site, headaches, and temporary hoarseness. More serious side effects, such as infection and damage to the surrounding tissue, or blood clot (hematoma) formation are serious, but with proper imaging and experience, are very rare. Patients should discuss the risks and benefits of SGB treatment with their doctor before undergoing the procedure.
Contraindications and Precautions
SGB treatment is not suitable for everyone. Patients who are taking blood thinners, have an active infection, or have certain medical conditions may be advised against undergoing the procedure. Patients should discuss their medical history with their doctor before undergoing the treatment.
SGB treatment is a medical procedure that can be used to treat a range of conditions, including PTSD, anxiety disorders, and chronic pain conditions. While it carries some risks, it is generally considered to be safe and effective. Contact Edelica Health today to learn if you’re a suitable candidate for SGB treatment!