Use Of Stellate Ganglion Block Research Articles

Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article.

For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress.

Stellate Ganglion Blocks for Post-COVID-19 Headaches: Case Report

BACKGROUND: Long COVID can impact patients with a wide range of new, returning, or ongoing health symptoms, lasting for months to years despite recovery from the acute infection. One of the symptoms is headaches. Post-COVID-19 headaches can affect the quality of life for many patients, and as a result, the management and treatment of the symptoms have become important issues. CASE REPORT: We present a case series of patients with varying presentations of post-COVID-19 symptoms, including headaches, who responded positively to the use of stellate ganglion blocks (SGBs). CONCLUSIONS: We report the successful use of a right-sided SGB for varying post-COVID-19 symptoms. KEY WORDS: Long COVID, post COVID, post-COVID headache, headaches, stellate ganglion block, case report

Stellate ganglion block with procaine in breast cancer survivors with hot flashes and sleep disturbances undergoing Endocrine Therapy.

Breast cancer survivors under endocrine therapy (ET) suffer from side effects such as hot flashes and sleep disturbance accompanied by poor quality of life. Many quit ET early and reduce their survival rate. Guidelines recommend gabapentin next to yoga or acupuncture. The role of side effects related to compliance with ET over years require new and effective therapies. Stellate ganglion block (SGB) has shown evidence of safety and efficacy and was found to be more effective than pregabalin without side effects. However, practical guidelines for the long-term use of SGB are still missing. We primarily used procaine instead of bupivacaine presuming effectiveness paired with lower toxic risks. Twenty-nine breast cancer survivors with severe hot flashes and sleep disturbance under ET received SGB with Procaine. Diaries recorded hot flashes and sleep quality scores up to week 24. All patients took part and none refused SGB. Each Patient received one SGB every 4 weeks without any side effects observed. Weekly scores were reduced from baseline by -33.6% (P < .01) (hot flashes) and -22.3% (P < .01) (sleep disturbances) after 4, and by -58.8% (P < .01) (hot flashes) and -50.8% (P < .01) (sleep disturbances) after twenty-for weeks. A wavelike reduction indicated a limited effect of a single SGB during continuous ET. We showed, that procaine in SGB is as effective as bupivacaine with lower risks and costs. High significant reductions in hot flashes and sleep disturbances after 1 and 6 months were found. We conclude that breast cancer survivors need individual treatment with SGB due to her personal impact. Hence, SGB should find its way to guidelines and daily routines as a valuable method for treating side effects in breast cancer survivors undergoing ET.

Use of Stellate Ganglion Block to Treat Anosmia and Dysgeusia Associated With COVID-19: A Narrative Review

Use of Stellate Ganglion Block to Treat Anosmia and Dysgeusia Associated With COVID-19: A Narrative Review

Use of Stellate Ganglion Block to Treat Anosmia and Dysgeusia Associated With COVID-19: A Narrative Review

Use of Stellate Ganglion Block to Treat Anosmia and Dysgeusia Associated With COVID-19: A Narrative Review

Successful Stellate Ganglion Block in Patients with Treatment Resistant Post-Traumatic Stress Disorder: A Case Series and Recent Literature Review

BACKGROUND: Post-traumatic stress disorder (PTSD) is an increasing health concern in both those with and without previous military experience. There is a growing body of evidence for the use of stellate ganglion block (SGB), a procedure performed to treat pain conditions and cardiac arrythmias, in the treatment of PTSD. There have been multiple clinical studies, randomized and nonrandomized, that have demonstrated positive results for the use of SGB. CASE REPORT: In this case series, we present 3 patients with military background and treatment resistant PTSD who underwent SGBs. All 3 patients experienced a decrease in their clinical symptoms and improved quality of life. CONCLUSION: Patients with refractory PTSD may benefit from SGB for treatment of their symptoms. PTSD symptoms may be sympathetically mediated, lending to the effect of SGB for symptom management. Data from recent clinical trials demonstrate a statistically significant reduction in PTSD symptoms when compared to sham procedures. KEY WORDS: Case series, literature review, local anesthetic, post-traumatic stress disorder, randomized control trial, stellate ganglion block, superficial cervical ganglion block, trauma

Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients.

The stellate ganglion block (SGB) procedure has been used successfully for over twelve years to treat thousands of patients suffering from posttraumatic stress disorder (PTSD). Level 1b evidence supports this use of SGB, but no studies to date have reported specifically on anxiety symptom improvements following SGB. We collected Generalized Anxiety Disorder questionnaire (GAD-7) scores pre-procedure and at 1-week and 1-month post-procedure from 285 patients. The mean baseline GAD-7 score of 15.9 (indicating severe anxiety) declined significantly following SGB treatment. Changes in GAD-7 scores ≥ 4 were considered clinically meaningful. From baseline to 1 week, the GAD-7 scores dropped by 9.0 points (95% CI = 8.3-9.7, p < 0.001, d = 1.8), with 211 (79.6%) patients demonstrating clinically meaningful improvement. Furthermore, from baseline to 1 month, the GAD-7 scores dropped by 8.3 points (95% CI = 7.6-9.0, p < 0.001, d = 1.7), with 200 (75.5%) patients demonstrating clinically meaningful improvement. The stellate ganglion block treatment resulted in a decrease of GAD-7 scores of over twice the minimal clinically important difference in treating anxiety for at least 1 month following SGB. Given the results from this retrospective observational study, larger prospective studies should be conducted to determine the effects of SGB treatment as a novel therapeutic treatment for generalized anxiety disorder and other anxiety disorders.

Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions.

Cervical sympathetic or stellate ganglion blocks (SGBs) have been commonly used in the treatment of painful conditions like complex regional pain syndrome (CRPS). However, there is literature to suggest its utility in managing non-painful conditions as well. The focus of this literature review is to provide an overview of indications for SGB for painful and non-painful conditions. We identified published journal articles in the past 25 years from Embase and PubMed databases with the keywords "cervical sympathetic block, stellate ganglion blocks, cervical sympathetic chain, and cervical sympathetic trunk". A total of 1556 articles were obtained from a literature search among which 311 articles were reviewed. Among painful conditions, there is a lack of evidence in favor of or against the use of SGB for CRPS despite its common use. SGB can provide postoperative analgesia in selective surgeries and can be effective in temporary pain control of refractory angina and the acute phase of herpes zoster infection. Among non-painful conditions, SGB may have beneficial effects on the management of post-traumatic stress disorder (PTSD), refractory ventricular arrhythmias, hot flashes in postmenopausal women, and breast cancer-related lymphedema. Additionally, there have been various case reports illustrating the benefits of SGB in the management of cerebral vasospasm, upper limb erythromelalgia, thalamic and central post-stroke pain, palmar hyperhidrosis, orofacial pain, etc. In our review of literature, we found that SGB can be useful in the management of various non-painful conditions beyond the well-known treatment for CRPS, although further studies are required to prove its efficacy.

A Review of Stellate Ganglion Block as an Adjunctive Treatment Modality.

Peripheral nerve blocks are becoming increasingly used as adjunctive treatment modalities for a variety of conditions refractory to medical management. Right or left stellate ganglion blocks (SGB) are a specific type of peripheral nerve block that target the sympathetic blockade of neuronal impulses using the injection of local anesthetic and steroids into nerve bundles in the cervical area. This review article is intended to summarize the common uses of stellate ganglion blocks and explain the procedural technique, which has evolved with technological advances in ultrasonography. The similarities between these disease processes are centered around sympathetic hyperactivity. This sympathetic overdrive state is created by increased levels of nerve growth factor (NGF), which causes a cascade of sympathetic sprouting resulting in increased norepinephrine (NE) systemically. Reversal of this cascade by local anesthetic injection into the stellate ganglion thereby reduces NGF and sympathetic sprouting subsequently lowering overall norepinephrine levels. This is the unifying theory by which SGB is able to provide resolution for the varied clinical conditions described in this article. This review article discusses the physiology of several conditions where stellate ganglion blocks are being investigated as an adjunct treatment modality, including anosmia, PTSD, long-COVID, chronic fatigue syndrome, menopausal hot flashes, and ventricular tachyarrhythmias. Overall, the current literature supporting the use of stellate ganglion blocks for several esoteric conditions is limited; however, case reports to date have shown promising evidence-based results supporting their use as an adjunctive treatment among patients with refractory symptoms to existing treatment algorithms. In conclusion, SGB should be considered among patients with refractory symptoms for medical management in the conditions discussed in this article. Further research is needed to delineate which patients will benefit from the use of SGB, the use of subsequent blocks and timelines in between injections, and unilateral versus bilateral blockade.

Local Injection for Treating Mood Disorders (LIFT-MOOD): A Pilot Feasibility RCT of Stellate Ganglion Block for Treatment-Resistant Depression

Background With nearly one-third of patients with major depressive disorder being resistant to available antidepressants, there is a need to develop new treatments for this population. Stellate ganglion block (SGB) is a procedure used to block sympathetic input to the central autonomic system; it has been administered to treat several conditions, including pain. Recently, indications for SGB have extended and the potential benefits for psychiatric disorders are under investigation. Methods The Local Injection For Treating Mood Disorders (LIFT-MOOD) study investigated the feasibility of a trial of 2 right-sided injections of bupivacaine 0.5% (7 mL) at the stellate ganglion in participants with treatment-resistant depression (TRD) using a randomized, placebo-controlled, pilot trial. Ten participants were randomized in a 1:1 allocation to receive active treatment or placebo (saline). Primary feasibility outcomes included recruitment rate, withdrawal, adherence, missing data, and adverse events. As a secondary, exploratory objective, we explored the efficacy of SGB in improving symptoms of depression by calculating the change in scores from baseline to follow-up on day 42 for each treatment group. Results The recruitment rate was reasonable and sufficient, retention and adherence were high, missing data were low, and adverse events were mild and temporary. Both treatment groups demonstrated decreases in Montgomery-Åsberg Depression Rating Scale scores, compared to baseline, by the end of the study. Conclusion This study supports the feasibility of a confirmatory trial of SGB in participants with TRD. Conclusions regarding efficacy cannot be made based on this preliminary study due to the small number of participants who completed active treatment. Larger-scale randomized controlled trials with long-term follow-ups and alternate sham procedures are needed to assess the efficacy and duration of symptom improvement with the use of SGB in TRD.

Stellate Ganglion Block as Pain Management in Post Herpetic Neuralgia: A Case Report

Introduction: Stellate ganglion block (SGB) has been used in various conditions. Medical conditions include complex regional pain syndrome and peripheral vascular disease. This study aims to describe the use of stellate ganglion block for pain management in post-herpetic neuralgia.&#x0D; Case presentation: A 68-year-old man came with a complaint of severe headache. Complaints of severe headache since 1 month ago, pain until tears come out. This complaint is accompanied by red blisters, pain on the left side of the face, weakness, and decreased appetite. Physical examination showed compos mentis consciousness, appeared moderately ill, blood pressure 160/90 mmHg, heart rate 112x/minute, respiratory rate 20x/minute, temperature 37.2oC, numeric rating scale 7/10. In the head region, there was cicatricial, paresis of N VII, positive hypersensibility, positive allodynia, spasm neck muscles, right joint shoulder stiffness, and stiffness in the m. right rotator cuff. The patient was given intervention in the form of a stellate ganglion block (SGB). Follow-up 1 day after the GBS procedure showed that the headache and left facial pain were greatly reduced.&#x0D; Conclusion: Ultrasonographic-guided stellate ganglion block can reduce post-herpetic neuralgia symptoms with minimal complications.

Stellate Ganglion Block Combined with Dexmedetomidine Protects Obese Rats from Lipopolysaccharide-Induced Acute Lung Injury.

Objective To investigate the effect and mechanism of combined stellate ganglion block (SGB) and dexmedetomidine (Dex) in obesity-related acute lung injury. Methods Thirty-six 4-week-old male Wistar rats were randomly divided into 6 groups, each with 6 rats: blank group (Control), high-fat diet group (HFD), high-fat + lipopolysaccharide (LPS)-induced acute lung injury group (HFD + LPS), SGB group, Dex group, and SGB + Dex group. H&E staining detected the pathological structure of rat lung tissue. TUNEL staining was used to examine cell apoptosis in lung tissue. Oxidative factors were accessed by biochemical reagents. ELISA was employed to measure the levels of TNF-α, IL-1β, and MCP1 in rat alveolar lavage fluid. Western blot detected the protein expression of glucose-regulated Protein 78 (GRP78), C/EBP homologous protein (CHOP), protein kinase R-like endoplasmic reticulum kinase (PERK), and p-PERK in lung tissue. Results The body weight of rats in the HFD group was higher than that in the control group. The use of SGB or Dex alone could significantly reduce the rate of pulmonary edema and lung cell apoptosis in HFD-induced obese rats and reduce MPO, TNF-α, IL-1β, and MCP1 levels, increasing the activity of SOD and GSH-Px. In addition, using SGB or Dex alone can also significantly reduce the protein expression levels of GRP78, CHOP, and p-PERK. The combined use of SGB and Dex can enhance the above effects. Conclusion The combined use of SGB and Dex can protect against obesity-related acute lung injury and is more effective than using SGB or Dex alone.

Stellate ganglion block as a treatment for vasomotor symptoms: Clinical application.

Vasomotor symptoms, also called hot flashes, hot flushes, and night sweats, are common during the menopause transition. Severe symptoms can substantially decrease quality of life. The authors first review current hormonal and nonhormonal therapies, then review evidence supporting the potential use of stellate ganglion block for managing vasomotor symptoms in perimenopausal and postmenopausal women.

Stellate Ganglion Block for the Treatment of Post-Traumatic Stress Disorder, Depression, and Anxiety

&#x0D; The evidence regarding the clinical effectiveness of stellate ganglion block for the treatment of post-traumatic stress disorder was mixed. A randomized controlled trial included in a systematic review did not detect significant differences in post-traumatic stress disorder symptoms in the stellate ganglion block versus sham groups, while another randomized controlled trial did detect significantly greater improvements in symptoms between these groups. Furthermore, the second randomized controlled trial detected significantly greater improvements in depression, anxiety, and distress, but not in pain and mental and physical functioning for participants receiving stellate ganglion block compared to sham.&#x0D; Authors of the randomized controlled trial included in the systematic review did not detect significant differences in rates of adverse events between groups. Of the 6 adverse events reported in the second randomized controlled trial, 3 were deemed related to stellate ganglion block treatment (injection site pain, self-resolving bradycardia, and temporary laryngeal irritation); the statistical analysis was not reported.&#x0D; Authors of 1 evidence-based guideline were unable to provide recommendations for or against the use of stellate ganglion block for the treatment of post-traumatic stress disorder because of insufficient evidence.&#x0D; No relevant literature or guidelines regarding the clinical effectiveness or use of stellate ganglion block for the treatment of depression or anxiety were identified.&#x0D;

Use of Stellate Ganglion Local Anesthetic Blockade for Treatment of Complex Regional Pain Syndrome Type-II of the Upper Extremity: A Case Report of One Patient’s Experience after Traumatic Hand Injury

Background: Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome associated with edema, muscle weakness, and hyperhidrosis. It can be precipitated by fracture, surgery, and spinal cord injury and usually involves the ipsilateral and sometimes contralateral extremity. Case Details: A 47-year-old male with CRPS Type-II involving the upper extremity had severe neuropathic pain that was limiting his ADLs despite medical, physical and occupational therapy. This case discusses the use of stellate ganglion block in the treatment of upper extremity CRPS Type-II. Conclusion: Stellate ganglion blockade is an effective adjuvant therapy in the treatment of CRPS Type-II when conservative therapy has failed to provide improvement in pain, highlighting a need for a multimodal therapeutic strategy. Keywords: Stellate ganglion block; Chronic pain; Complex regional pain syndrome type-II; Bupivacaine

PTSD Treatment Literature: Old and Fresh Approaches

PTSD is a brain disorder that exacts large costs to individuals, families, and society in general. Direct monetary costs that are associated with PTSD symptoms of U.S. military veterans have been increasing steadily. Less direct indicators of PTSD costs to society include the externalities of lower economic productivity, family dysfunction, PTSD comorbidities, drug, and alcohol addictions. Veteran awards linked to PTSD are conferred with the tacit assumption that “cures” for PTSD do not exist. Veterans Administration policies adopt the pharmacological strategy of dispensing drugs that have not been approved for PTSD usage by the U.S. Food and Drug Administration. Despite the existing government policies regarding PTSD treatment of veterans, emerging literature indicates that innovative PTSD treatments are available, that they deserve further scrutiny, and that they may present better alternatives to status quo options. In particular, noteworthy research regarding the use of stellate ganglion block or SGB appears to be promising. In addition to SGB research, literature has shown that approaches to PTSD such as physical activity, meditation, wilderness therapy, and self-help hold promise as treatments. Two treatment drugs, the selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) have been approved by the Food and Drug Administration (FDA) for relieving symptom of PTSD. However, the U.S. Food and Drug Administration warned that these drugs are accompanied with the risk of suicidal thoughts, hostility, and agitation. Equally, if not more troubling, the literature indicates that physicians commonly prescribe benzodiazepine tranquilizers (such as Valium and Xanax) to veterans even though Veterans Administration guidelines advise against their use for PTSD. The Veterans Administration dispensed these drugs to almost a third of veterans being treated for PTSD even though they recognized the need to exercise caution in their use. A review of the literature indicates that PTSD is a growing societal problem; that existing treatments show signs of being problematic, and that innovative treatment strategies deserve greater attention.

Effect of stellate ganglion block on postoperative recovery of gastrointestinal function in patients undergoing surgery with general anaesthesia: a meta-analysis

BackgroundThe return of gastrointestinal function is an important sign of postoperative recovery in patients undergoing surgery with general anaesthesia. We aimed to summarize the effects of stellate ganglion block on the recovery of gastrointestinal function as a means of exploring methods through which anaesthesiologists can contribute to postoperative patient recovery.MethodsWe performed a quantitative systematic review of randomized controlled trials published between January 1, 1988, and November 11, 2019, in PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, and the Wanfang and SinoMed databases. Study quality was assessed by using the GRADE criteria and bias of included studies were assessed using the revised Cochrane risk-of-bias tool for randomized trials. The time to peristaltic sound resumption, flatus, postoperative eating and the incidence of abdominal bloating in the stellate ganglion block and control groups were compared. The control group consisted of either a stellate ganglion block with normal saline or no treatment. Meta-analysis was performed using Review Manager software.ResultsAfter searching for relevant articles, 281 studies were identified, and five articles with data on 274 patients were eligible. Regarding postoperative flatus time, stellate ganglion block resulted in a mean reduction of 15 h (P = 0.02); then a sensitivity analysis was performed, and the standard mean difference decreased to 6 h (P = 0.007). For gastrointestinal surgery, the mean reduction was 23.92 h (P = 0.0002). As for the evaluation of the recovery of peristaltic sounds, stellate ganglion block promoted the recovery of regular peristaltic bowel sounds an average of 14.67 h earlier than in the control (P = 0.0008). When it comes to nutrients, stellate ganglion block shortened the total parenteral nutrition time by more than 50 h in patients who had undergone gastrointestinal surgery (P<0.00001). Finally, stellate ganglion block prevented the occurrence of postoperative abdominal bloating (P = 0.001).) No complications related to stellate ganglion block were reported.ConclusionStellate ganglion block may promote postoperative gastrointestinal recovery in patients undergoing various surgeries under general anaesthesia. However, additional trials investigating the use of stellate ganglion block are necessary to confirm our finding.Trial registrationThis meta-analysis has been registered at the International Prospective Register of Systematic Reviews (registration number CRD42020157602).

Use of Stellate Ganglion Block to Treat Posttraumatic Stress Disorder: A Narrative Review

Use of Stellate Ganglion Block to Treat Posttraumatic Stress Disorder: A Narrative Review

P4609The use of stellate ganglion block in the management of electrical storm reduces VA burden by 92% and completely excludes the need for general anesthesia

Abstract Background The electrical ventricular storm (ES) is a life-threatening condition. The treatment is based on addressing the triggering cause, influencing reversible factors, patient sedation, and antiarrhythmics. Suppressing the massive sympathetic surge is a keystone in the emergent management. Stellate ganglion block (SGB) might serve this purpose. Purpose To show the efficacy of ultrasound-guided SGB in the management of ES. Methods Retrospective analysis of case series. All ES patients in whom SGB was used. SGB was performed after the initial failure of reversible factors modification + sedation + antiarrhythmics. We compared the mean VA burden 2 days before vs. 7 days after SGB (to show the long effect of SGB). 31 patients (5 females). Procedure date between 01.03.2017 and 21.11.2018. Mean LVEF 27±9%. Etiology: 74% ischemic vs. 26% non-ischemic cardiomyopathy. Antiarrhythmic treatment: amiodarone 27 pt. (87%), trimecaine 3pt (10%), digoxin 2 pt. (6%), beta-blocker 28 pt. (90%). Results The ES management including SGB resulted in a significant decrease (92%) in VA burden (mean 26,0 episodes/day vs. 0,6 episodes/day; p&lt;0.001). Separately, ATP episodes were reduced by 99%, external or ICD shocks by 76%. There was no need for general anesthesia as a last resort in refractory ES. 30-days mortality 12,9%. No significant adverse events have been noticed, 10 pt. (32,3%) have developed Horner syndrome, which always disappeared in 24 hours. Conclusion Ultrasound-guided SGB in the management of ES is safe and very effective. Randomized prospective studies are required to precisely determine the effect of SGB.

A review of the use of stellate ganglion block in the treatment of PTSD.

Current treatments for PTSD are often not effective or acceptable to the patient. There are a number of emerging new treatments. One promising new one is stellate ganglion block, an anesthetic treatment for pain which relieves symptoms of severe and chronic PTSD in some patients. The focus of this chapter is to summarize clinical evidence available for the effectiveness of cervical sympathetic ganglion injection called stellate ganglion block (SGB), as well as demonstrate possible clinical applications of its use. Cervical sympathetic blockade involves injecting a local anesthetic next to a group of nerves (ganglion) in the neck. The technique has been used clinically since 1925 with very few side effects. Finally, the neurobiology of SGB is discussed. Challenges to the use of SGB include the lack of randomized clinical trials and practitioners familiar with the use of SGB for PTSD.