Frequently Asked Questions: Stellate Ganglion Block

What are the risks?

The overall risks of SGB are very small (much less than 1 in 1000) of having a significant adverse event when done by a skilled provider with ultrasound guidance. There is a very small risk of a seizure from inadvertently injecting the local anesthetic into blood vessel, there is a very small risk of forming a dangerous hematoma (collection of blood from a bleeding blood vessel). This risk is very small in people not taking blood thinning medications. SGB should not be done in people currently on blood thinning medications. About 15 percent of the time people get a hoarse voice or a feeling like there is something in the back of their throat for anesthetic spread to another nerve near the larynx. This is not a mistake, it just happens sometimes. The hoarse voice or feeling in your throat, if it occurs, will wear off in a 3-6 hours.

How many treatments does it usually take?

About 50% of people successfully treated to not need another SGB. Some people may be exposed to conditions that “re-trigger” their PTSD symptoms and need another treatment in the future. It can be safely repeated if needed, and if it was helpful the first time. That is why doing your follow up PCL-5 at one week and one month after your SGB is very important, so we can document if this was a good therapy for you. In rare cases (about 1 in 100) people that seem to be a good candidate for SGB will not respond to a block done on the right side (where most people respond). For these people, I and others have had success by they doing a SGB on the left side at least two days later for safety reasons. (Never have a block on both sides of the neck within a 24-hour period, in theory this could block an airway).

What is the percentage of success?

We carefully screen our potential patients to select people that have the best chance of having success with the SGB. In a properly selected patient, we have a better than 85% success rate (defined by significant improvements in the PCL-5 score).

How Many of these has Dr. Mulvaney done?

Over a 10-year period Dr. Mulvaney has done over 1000 ultrasound-guided SGBs and is one of the most experience physicians at this technique. He has taught hundreds of physicians neck sonographic anatomy and SGB technique. As a fellowship-trained and board-certified interventional pain physician, he is also proficient in fluoroscopically (x-ray) guided SGBs, but he strongly feels this method is both more painful, less accurate and unnecessarily exposes patients to ionizing radiation.

Are you treated in the same appointment?

If you are coming from out of the Annapolis area, we will do our best to properly screen you before your appointment, so we can assess you and treat you in the same visit. If you are from the local area, we may do a separate screening appointment before treatment.

Can I drive after this procedure?

The accepted medial practice is that you cannot drive for 8 hours after this procedure.

How Can SGB help PTSD symptoms?

The Stellate Ganglion is part of the cervical sympathetic chain, a key part of the sympathetic nervous system, which is the “fight or flight” nervous system. In PTSD or 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. I and other researchers believe this allows the brain and the body to “reset” back to a non-anxiety state. What we do know and can measure is this “resetting” results in long-term relief of anxiety symptoms.

What is the closest airport?

Our office is in Annapolis, Maryland. Baltimore Washington International Airport (BWI) is 25 minutes to the North, Reagan International airport is 50 minutes away, however this involves traveling on the 495 Beltway, with heavy rush hour(s) traffic. Dulles International Airport is over 2 hours away and subject to heavy traffic. There are many Hotel options from all the major hotel chains in the greater Annapolis area.

What is SGB used to treat?

In my clinical practice and research, I have mostly used and published on using SGB to treat the anxiety symptoms associated with PTSD. I have also used it successfully to treat some anxiety conditions which have overlapping symptoms with PTSD.

What does SGB not treat?

SGB is not a treatment for Depression, Bipolar disorder, Schizophrenia or any variants of Schizophrenia, Personality Disorders, Seizure disorders. Traumatic Brain Injury (TBI) and PTSD symptoms can overlap, but I have not found SGB to be helpful for TBI, but it can help the PTSD symptoms that may also be present.