A Review of Stellate Ganglion Block as an Adjunctive Treatment Modality

Abstract

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.

Keywords: adjunctive therapy; anosmia; hot flashes; long-covid; menopause; peripheral nerve block; ptsd; sgb; stellate ganglion block; ventricular tachycardia.

Figure 1. Ultrasound-guided stellate ganglion block at the level of C6 transverse process.

SCM: sternocleidomastoid muscle; CA: right carotid artery; LCL longus colli muscle; N: needle; star symbol: sympathetic chain. This figure is an original illustration by the authors of this paper. Ultrasound was obtained during a patient visit by Dr. Krishna Shah. Patient information was deidentified and the screenshot was used for the purposes of this article [4].

Figure 2. Confirmation of unilateral Horner's syndrome following stellate ganglion block.

This figure is an original contribution by the authors of this paper. Photograph was taken of a patient following successful stellate ganglion block for long-COVID demonstrating ipsilateral Horner syndrome [4].