FAQ's

The injection is similar to sustaining a small bee sting. Options for sedation are available if requested.

For most procedures, local anesthesia is used, which blocks or reduces sensation of the overlying structures. This numbing medication is placed into the skin by the physician through a very small needle. A relatable example is when a dentist numbs the nerve to the tooth prior to performing a root canal.

Most of the time only local anesthesia is required. In certain circumstances, conscious sedation may be used. An IV is usually placed in the patient’s arm and sedating and/or pain-relieving medication is administered. This medication travels its way throughout most of the body. With conscious sedation, patients are not advised to eat heavy meals up to 8 hours before the procedure, light meals up to 6 hours before the procedure, and clear liquids up to 2 hours before the procedure.

Although patients may be hungry and tired, there is a risk of vomiting due to a possible reaction to the anesthesia. The vomit may enter the wrong tube and subsequently enter the lungs. This is known as “aspiration” and could be deadly. It is mandatory that a driver, who is a friend or family member of the patient, takes the patient directly home. Certain patients may not be conscious sedation candidates, such as those with severe kidney failure or cardiovascular disease.

Unfortunately the stellate ganglion block (SGB) is not covered by health insurance when used for PTSD. If you are interested in the SGB please call our office at (305) 459-3300 and we will be happy to answer all of your questions.

Unfortunately, most treatments for the above conditions do not actually fix the condition. For example, anti-depressant medications typically release certain molecules that are low in patients with depression; however, this does not address the actual underlying mechanism for why these molecules are low in the first place. Patients rely on these medications to provide the missing amount of these molecules to feel just well enough to get through the day. These molecules should naturally be released by the brain without help from the medications. The stellate ganglion block helps to restore normal function to the “fight or flight” system. The SGB addresses and fixes the responsible mechanism that drives the undesired symptoms of PTSD.

The procedure is extremely low risk. There are rarely serious complications as long as the physician is properly trained and experienced in performing the procedure. The list of most common potential complications is as follows: allergic reaction, temporary or permanent nerve damage, paralysis, internal bleeding, hematoma formation, infection/abscess formation, puncture of the spinal cord or its surrounding layers, spinal fluid leakage with possible headache, stroke, seizure, respiratory distress, pneumothorax, hoarse voice, palpitations, heart attack, difficulty swallowing, local anesthetic toxicity with neurologic and cardiac defects, and procedure failure.

Above the collar bone in the front of the neck, usually on the right side.

The duration of relief is different for everyone so it’s hard to say. It can be months or even years of relief with the average being around 6 months.

No, it should actually bring you back to a pre-traumatic mental health state where your emotions are balanced and you feel like your normal self again.

You should have a discussion with the medical provider prescribing you these medications; however, it is quite possible that you will no longer need to take related medications if you are feeling great.

A successful stellate ganglion block will demonstrate the following signs in the eye on the side of the procedure: droopy eyelid, redness of the white portion of the eye, pinpoint pupil, and blurry vision. Additionally, the arm and face will be warmer and appear more red, there may be less moisture of the skin, there may be difficulty swallowing, the voice may be hoarse, and the nostril may become congested. All of these effects should disappear within a few hours from the procedure.

The patient may experience localized pain and/or numbness. There may be some mild bleeding from the needle insertion site, dizziness/lightheadedness, facial flushing, and non-positional headache. The blood pressure may rise. Infrequently, a brief episode of loss of consciousness may even occur, which is usually due to an anxiety reaction in which the blood pressure suddenly drops temporarily without any permanent or lasting effects.

The patient may be transported to a recovery room and re-evaluated. Certain feelings may be normal or common; however, it is important for the physician and staff to know what is happening in the event that something wrong has occurred or is actively occurring. Once the patient is deemed stable, he/she is discharged. The patient should inform the physician or the staff of any questions or concerns.

No, as the medications used are short-acting local anesthetics.

Active infection or cancer overlying the site of needle entry.

Yes.

Alino J., Kosatka D., McLean B., Hirsch K. Efficacy of stellate ganglion block in the treatment of anxiety symptoms from combat-related posttraumatic stress disorder: a case series. Mil Med 2013; 178: e473–6.

Alkire, M. T., Hollifield, M., Khoshsar, R., Nguyen, L., Alley, S. R., & Reist, C. (2015). Neuroimaging suggests that stellate ganglion block improves post-traumatic stress disorder (PTSD) through an amygdala mediated mechanism. In American Society of Anesthesiology annual meeting. American Psychiatric Association: The Diagnostic and Statistical Manual of Mental Disorders, Ed 4, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Ferrada‐Noli M., Asberg M., Ormstad K., Lundin T., & Sundbom E. (1998). Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 11(1), 103-112.

Geracioti T.D. Jr, Baker D.G., Ekhatur N.N., et al: CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry 2001; 158: 1227–30.

Hanling S. R., Hickey A., Lesnik I., Hackworth R. J., Stedje-Larsen E., Drastal C. A., & McLay R. N. (2016). Stellate ganglion block for the treatment of posttraumatic stress disorder: A randomized, double-blind, controlled trial. Regional anesthesia and pain medicine, 41(4), 494-500.

Hickey A. H., Navaie M., Stedje-Larsen E. T., Lipov E. G., & McLay R. N. (2013). Stellate ganglion block for the treatment of posttraumatic stress disorder. Psychiatric Annals, 43(2), 87-92.

Isaacson L.G., Billieu S.C. Increased perivascular norepinephrine following intracerebroventricular infusion of NGF into adult rats. Exp Neurol 1996; 139(1): 54–60.

Karnosh L.J., Gardner W.J. (1947) The effects of bilateral stellate ganglion block on mental depression; report of 3 cases. Cleve Clin Q 14: 133-138. (http://www.ncbi.nlm.nih.gov/pubmed/20250097).

Lipov E. G., Joshi J. R., Lipov S., Sanders S. E., & Siroko M. K. (2008). Cervical sympathetic blockade in a patient with post-traumatic stress disorder: a case report. Annals of Clinical Psychiatry, 20(4), 227-228.

Lipov E. G., Navaie M., Brown P. R., Hickey A. H., Stedje-Larsen E. T., & McLay R. N. (2013). Stellate ganglion block improves refractory post-traumatic stress disorder and associated memory dysfunction: a case report and systematic literature review. Military medicine, 178(2), e260-e264.

Lipov E. G., Joshi J. R., Sanders S., & Slavin K. V. (2009). A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Medical hypotheses, 72(6), 657-661.

Moore D. P., & Puri B. K. (2012). Textbook of Clinical Neuropsychiatry and Behavioral Neuroscience 3E. CRC Press.

Mulvaney S.W., Lynch J.H., Hickey M.J., et al. Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients. Mil Med. 2014;179(10):1133–40.

This is the largest publication so far on the use of SGB in military PTSD. Takano M., Takano Y., Sato I. (2002) Unexpected beneficial effect of stellate ganglion block in a schizophrenic patient. Can J Anaesth 49: 758-759.

(http://www.ncbi.nlm.nih.gov/pubmed/12193502). Takatori M., Kuroda Y., & Hirose M. (2006). Local anesthetics suppress nerve growth factor-mediated neurite outgrowth by inhibition of tyrosine kinase activity of TrkA. Anesthesia & Analgesia, 102(2), 462-467.