The Successful Use of Left-sided Stellate Ganglion Block in Patients That Fail to Respond to Right-sided Stellate Ganglion Block for the Treatment of Post-traumatic Stress Disorder Symptoms: A Retrospective Analysis of 205 Patients

Abstract

Introduction Ultrasound-guided stellate ganglion block (SGB) is an injection of local anesthetic (8mL of 0.5% ropivacaine) in the neck to temporarily block the cervical sympathetic trunk which controls the body’s fight-or-flight response. This outpatient procedure takes less than thirty minutes and is immediately effective. Our goal was to determine if a left-sided stellate ganglion block is effective for treating posttraumatic stress disorder (PTSD) symptoms. While right-sided SGB has been extensively studied, left-sided SGB has not been formally evaluated for this indication. Materials and Methods Our hypothesis was that patients who fail to improve following a right-sided SGB will report significant improvement following a left-sided SGB. A retrospective chart review was conducted for patients who received SGB for PTSD symptoms between August 2019 and March 2020. All procedures were performed at an established musculoskeletal practice by the same anesthesia/pain fellowship-trained physician. Subjects included those who underwent a left-sided SGB (LSGB) only after non-response to a right-sided SGB (RSGB). Non-response was defined as less than 10 points of improvement on a PTSD Checklist (PCL-5). Results Out of 205 patients, 20 did not respond to an RSGB and were included in our analysis. Ten of these patients subsequently received an LSGB, and 90% responded favorably (PCL-5 mean improvement = 28.3 points). Conclusions Based on our sample of 205 patients receiving SGB for PTSD, we concluded that at least 4.4% did not respond to a right-sided SGB but did have a significant response to a left-sided SGB.

Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape

“…Two of the 5 clinical trials were RCTs, 11,14 whereas the other 3 followed an open-label design and were nonrandomized. [15][16][17] Both published RCTs utilized masking and followed a parallel assignment interventional model, while all of the open-label trials followed a singlegroup interventional model. One open-label trial utilized pulse radiofrequency as an adjunctive treatment to SGB.…”

“…11 The nonrandomized open-label trials were published in 2014, 15 2016, 16 and 2021. 17 One case study, series, or survey was published annually in each of 1955, 19 2002, 21 2008, 24 2010, 29 2014, 18 and 2019, 25 and 2 were published annually in each of 2012, 26,28 2013, 20,22 and 2015 23,27 (Figure 2a).…”

“…Both RCTs and all 3 nonrandomized trials examined SGB in patients with PTSD. 11,[14][15][16][17] Ten of the case studies, series, and surveys reported on the use of SGB for PTSD, 18,20,[22][23][24][25][26][27][28][29] whereas 2 reported on the use of SGB in individuals with schizophrenia spectrum disorders (SSDs) 19,21 (Figure 2b). Registered Clinical Trials.…”

“…11,14 Among the nonrandomized open-label trials that specified age, the mean age of participants were 36 and 53 years old. 16,17 One trial had only male participants, 16 another had 60% female participants, 17 and the third did not specify. 15 One study had 1 to 10 participants, 17 while the others had 11 to 50.…”

“…16,17 One trial had only male participants, 16 another had 60% female participants, 17 and the third did not specify. 15 One study had 1 to 10 participants, 17 while the others had 11 to 50. 15,16 The mean age of participants in case studies, series, and surveys ranged from 36 to 67.8 years old, and most were male.…”