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Is a Stellate Ganglion Block Dangerous?

Understanding the Risks and Benefits of This Interventional Procedure

Stellate Ganglion Blocks (SGB) may sound daunting at first—after all, the idea of an injection into the neck can understandably raise concerns. You might even ask, “is a Stellate Ganglion Block dangerous?” But SGB is a well-established, minimally invasive procedure with a proven track record of helping patients manage conditions like PTSD and anxiety. This nerve block targets the stellate ganglion, a crucial part of the sympathetic nervous system, and offers relief from overactive stress responses. Let’s explore how this treatment works and why, despite its intimidating reputation, it is considered both safe and effective. 

Stellate Ganglion Block Safety

Before we explore the risks, or aspects of the procedure that may look “dangerous” at first glance, let’s first cover the safety measures, and results as indicated in multiple studies. 

FDA Approval (for pain)

Stellate Ganglion Blocks approved for pain management use by the FDA. Today, they are increasingly used to address PTSD and anxiety. For treatment of patients with mental health conditions, the Blocks are considered “off-label,” meaning that although the FDA has approved them for pain management care, it has not approved their use for these conditions–yet. However, the same safety protocols are applied to Stellate Ganglion Block injection for PTSD and anxiety, as for chronic pain conditions, like Complex Regional Pain Syndrome.

Advanced Ultrasound Guidance

This advanced injection requires the use of ultrasound guidance to help physicians precisely inject the stellate ganglion nerve cluster. 

Safety Results

In 2015 Dr. Brian McLean published the reviewed outcomes of over 250 Stellate Ganglion Blocks administered over an 18-month period. The review of this sample size found zero immediate or delayed complications, and 100% of the surveyed participants were satisfied with the process and procedure and would recommend it to friends.(6) Additionally, a multi-site clinical trial also found SGB to be a safe, routine procedure.(7)

Stellate Ganglion Block Risks

Though Stellate Ganglion Blocks for anxiety, depression, and pain have been proven to be relatively safe and low-risk, some patients do experience mild temporary side effects following their procedures.(8)

Stellate Ganglion Block Side Effects

  • Horner’s Syndrome— Characterized by a temporarily drooping eye, this effect may occur if the anesthetic affects nearby nerves and typically resolves on its own.
  • Hoarseness— Since the injection site is near the vocal cords, some patients may experience hoarseness or difficulty speaking after the procedure. This usually resolves within a few hours to a day.
  • Difficulty Swallowing— Because the procedure is close to the esophagus, some patients may have mild difficulty swallowing. This, too, tends to be short-lived.
  • Hematoma Formation— Refers to the collection or pooling of blood outside of blood vessels, usually caused by an injury to the walls of the blood vessels.
  • Severe Hypertension— Though rare, in some cases, an SGB can cause an imbalance in the autonomic nervous system, which may lead to a spike in blood pressure.

Though these mild side-effects are somewhat common, they typically dissipate within hours of the injection. 

SGB is not a new or experimental procedure—it has been used safely for decades to treat chronic pain conditions, and its application for PTSD and anxiety has gained significant clinical support in recent years. The use of modern imaging technologies, such as ultrasound and fluoroscopy, ensures precise needle placement, further reducing risks. These advancements allow physicians to target the stellate ganglion accurately, minimizing complications and improving overall patient safety. In fact, studies have consistently shown that when performed by experienced specialists using these techniques, the risk of serious complications is exceedingly rare. This track record, combined with patient satisfaction rates, solidifies SGB as a low-risk, highly effective intervention for many conditions.

Who Should Consider SGB?

The use of SGB has evolved over time. While it was initially developed for treating chronic pain and conditions like complex regional pain syndrome (CRPS), it has gained attention as a treatment for mental health disorders, particularly PTSD and anxiety. 

Studies indicate SGB may evoke profound improvements, especially for those with treatment-resistant disorders and have not experienced relief from other forms of treatment. 

PTSD

PTSD is classified as a mental health condition caused by an extremely terrifying or stressful event. SGB has been shown to have a 70%-80% success rate in treating PTSD symptoms. (9-13)

Anxiety

Generalized anxiety is a condition characterized by persistent feelings of unease and dread, and physical symptoms, like: increased heartbeat and blood pressure and hypervigilence. SGB has been shown to reduce symptoms of anxiety by 50%. (14)

What Happens During a Procedure?

A SGB procedure involves injecting a local anesthetic into the stellate ganglion to block nerve impulses. This can help reduce pain, alleviate PTSD symptoms, or manage conditions related to sympathetic nervous system dysfunction. The procedure is usually performed by a trained pain specialist or anesthesiologist.

Stellate Ganglion Blocks are widely acknowledged to be a relatively safe and low-risk procedures with high potential for positive outcomes. Although, some risks may apply so it is important to seek care from certified doctors trained in this type of specialized procedure. 

Want to learn if SGB is right for you? Schedule a Free Discovery Call to speak to a member of our team. 

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References

  1. Goel V, Patwardhan AM, Ibrahim M, Howe CL, Schultz DM, Shankar H. Complications associated with stellate ganglion nerve block: a systematic review. Reg Anesth Pain Med. 2019 Apr 16:rapm-2018-100127. doi: 10.1136/rapm-2018-100127. Epub ahead of print. PMID: 30992414; PMCID: PMC9034660.
  2. Huntoon MA. The vertebral artery is unlikely to be the sole source of vascular complications occurring during stellate ganglion block. Pain Pract. 2010 Jan-Feb;10(1):25-30. doi: 10.1111/j.1533-2500.2009.00310.x. Epub 2009 Sep 15. PMID: 19761512.
  3. Mahli A, Coskun D, Akcali DT. Aetiology of convulsions due to stellate ganglion block: a review and report of two cases. Eur J Anaesthesiol. 2002 May;19(5):376-80. doi: 10.1017/s0265021502000613. PMID: 12095020.
  4. Lu F, Tian J, Dong J, Zhang K. Tonic-clonic seizure during the ultrasound-guided stellate ganglion block because of an injection into an unrecognized variant vertebral artery: A case report. Medicine (Baltimore). 2019 Nov;98(48):e18168. doi: 10.1097/MD.0000000000018168. PMID: 31770265; PMCID: PMC6890314.
  5. Kimura T, Nishiwaki K, Yokota S, Komatsu T, Shimada Y. Severe hypertension after stellate ganglion block. Br J Anaesth. 2005 Jun;94(6):840-2. doi: 10.1093/bja/aei134. Epub 2005 Apr 22. PMID: 15849210.
  6. McLean B. Safety and Patient Acceptability of Stellate Ganglion Blockade as a Treatment Adjunct for Combat-Related Post-Traumatic Stress Disorder: A Quality Assurance Initiative. Cureus. 2015 Sep 10;7(9):e320. doi: 10.7759/cureus.320. PMID: 26487996; PMCID: PMC4601906.
  7. Rae Olmsted KL, Bartoszek M, Mulvaney S, et al. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry. 2020;77(2):130–138. doi:10.1001/jamapsychiatry.2019.3474
  8. Goel V, Patwardhan AM, Ibrahim M, Howe CL, Schultz DM, Shankar H. Complications associated with stellate ganglion nerve block: a systematic review. Reg Anesth Pain Med. 2019 Apr 16:rapm-2018-100127. doi: 10.1136/rapm-2018-100127. Epub ahead of print. PMID: 30992414; PMCID: PMC9034660.
  9. Lynch, James H et al. “Effect of Stellate Ganglion Block on Specific Symptom Clusters for Treatment of Post-Traumatic Stress Disorder.” Military medicine vol. 181,9 (2016): 1135-41. doi:10.7205/MILMED-D-15-00518
  10. 10 Lipov, Eugene G et al. “Stellate ganglion block improves refractory post-traumatic stress disorder and associated memory dysfunction: a case report and systematic literature review.” Military medicine vol. 178,2 (2013): e260-4. doi:10.7205/MILMED-D-12-00290
  11. 11 Mulvaney, Sean W et al. “Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients.” Military medicine vol. 179,10 (2014): 1133-40. doi:10.7205/MILMED-D-14-00151
  12. 12 Lynch, James H et al. “Behavioral health clinicians endorse stellate ganglion block as a valuable intervention in the treatment of trauma-related disorders.” Journal of investigative medicine : the official publication of the American Federation for Clinical Research vol. 69,5 (2021): 989-993. doi:10.1136/jim-2020-001693
  13. 13 Mulvaney SW, Lynch JH, Curtis KE, Ibrahim TS. 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 [published online ahead of print, 2021 Feb 13]. Mil Med. 2021;usab056. doi:10.1093/milmed/usab056
  14. Lynch JH, Mulvaney SW, Bryan CJ, Hernandez D. Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. Journal of Personalized Medicine. 2023; 13(6):958. https://doi.org/10.3390/jpm13060958

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