How the Stellate Ganglion Block (SGB) Can Augment Treatment Plans

How the Stellate Ganglion Block (SGB) Can Augment Treatment Plans
By stella
13th Feb 2022
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The following article refers to PTSD (Post-Traumatic Stress Disorder), whereas at Stella, we use the term PTSI (Post-Traumatic Stress Injury). We encourage you to adopt this language to break the stigma against Post-Traumatic Stress.  Read more about the shift from PTSD to PSTI here.

Individuals seeking relief from symptoms of post-traumatic stress, anxiety, and/or depression have many treatment options: pharmaceutical drugs, exposure therapy, EMDR, insight-oriented therapy, RTM, yoga, mindfulness-based stress reduction… The list goes on.

For many, the formula for lasting relief combines biological and psychological interventions. Think ketamine intravenous infusions plus group therapy or EMDR plus daily meditation.

The idea of researching all available treatments can be daunting. And deciding where to start our healing journey – or what to add to it – takes time and serious consideration. That’s where Stella comes in.

In this article, we explain the Stellate Ganglion Block by Stella and how it can treat symptoms of post-traumatic stress, anxiety, and/or depression. We’ll also describe how our Psychiatric Mental Health Nurse Practitioners create a custom care plan for each person they help.

What Is The Stellate Ganglion Block?  

When someone experiences a traumatic or highly stressful event, their body’s fight-or-flight response turns on, and sometimes it stays on long after the traumatic event. The over-activation of the fight-or-flight response can create extra nerve fibers in the brain, producing norepinephrine, a hormone responsible for increased heart rate and alertness, affecting sleep, mood, and memory. This culmination of events can lead to post-traumatic stress and its symptoms. Brain imagery data suggests that trauma causes a change that is visible in the brain, namely nerve growth around the amygdala.1

The Stellate Ganglion Block (SGB) is an injection of local anesthetic into the stellate ganglion – a bundle of nerves in the neck – that helps restore normal biological function and has the potential to relieve even the most severe symptoms of trauma. This can stop the nerve growth that is occurring and eliminate or prune the extra nerve fibers that have been created, thereby resetting the amygdala to its pre-trauma state.2

Stella’s Chief Medical Officer Dr. Eugene Lipov published the first case report that explores the use of SGB to proactively address trauma symptoms. He suggests that the local anesthetic temporarily “turns off” the stellate ganglion, which has been sending signals via nerve pathways to the amygdala, causing nerve growth.2

Stella is committed to driving quality research on SGB. Dr. Lipov created the industry-leading method for administering SGB effectively and published the first unified theory of how SGB works. Our network of providers follows strict SGB safety and emergency protocols, developed by Dr. Lipov.

What Makes SGB by Stella Different?

Historically, SGB has been used for pain management. For this indication, SGB consists of a single injection on the right side of the neck.

After researching and testing many ways of administering SGB, Dr. Lipov found that two injections – known as the “Dual Sympathetic Reset” – yield the best results. The injections are made at vertebrae C6 and C4 (or C3) on the right side of the neck.

The Benefits of SGB by Stella

We do not require trauma histories.

To determine if someone is a good candidate for Treatment by Stella, they’ll schedule an initial consultation with a licensed Psychiatric Mental Health Nurse Practitioner (PMHNP). Stella’s PMHNP will review an individual’s symptoms and health history to create a custom care plan.

During this process, the PMHNP will never ask the individual to disclose anything about the trauma(s) they’ve experienced. The PMHNP simply needs to understand if the individual is experiencing symptoms that indicate the need for Stella’s biological interventions – like SGB or Ketamine Infusion Therapy.

SGB can accelerate the positive impact of existing treatments.

It can be difficult to attend therapy or make continual progress when symptoms of post-traumatic stress, anxiety, and/or depression are in control. After SGB, Stella’s patients report a sense of calm that allows them to be more present during therapy in ways that felt impossible before.

SGB can happen at any point on a healing journey.

Whether trauma was experienced months or decades ago, SGB may be a good treatment option.

Many of our patients are encouraged to learn that SGB is an effective treatment option regardless of gender, trauma type, age, PTSD-related medication use, or history of suicide attempts.4

SGB takes less than 20 minutes. 

The injection itself takes less than 20 minutes.

On the day of the procedure, individuals can expect to spend several hours at the treatment location to allow time to check in, twilight sedation (if available), SGB, and follow-up observations.

SGB is safe.

Who performs the Stellate Ganglion Block? Every Stella doctor is Board Certified and personally trained by Dr. Lipov in our proprietary methodology. We also require our doctors to use image guidance for correct needle placement.

What medication is used in a Stellate Ganglion Block? The local anesthetics Stella uses are Bupivacaine or Ropivacaine, both of which are FDA-approved.

Serious side effects are extremely rare.

Stella’s Clinical Approach

Stella takes a trauma-informed approach to treatment and communication. We recognize that everyone experiences and processes their symptoms of post-traumatic stress, anxiety, and/or depression differently. Our Care Team meets our patients exactly where they are. After an initial consultation with a Psychiatric Mental Health Nurse Practitioner (PMHNP) and the support of Stella’s Care Team, our patients can make an informed decision about the next step on their healing journey.

We respect our patients’ relationships with other mental health care providers, doctors, and healers. Our PMHNPs will work with each patient’s healthcare team to help them find lasting relief from symptoms of post-traumatic stress, anxiety, and depression.

PTSD Medications & SGB

Before determining if SGB is right for an individual, a PMHNP will review the individual’s list of current medications. Most prescription and over-the-counter medications do not interact with either of the local anesthetics – Bupivacaine or Ropivacaine – that Stella doctors use for SGB.

Like many other medical procedures and surgeries, Stella requires that blood thinners be stopped a few days before the SGB procedure, as they can cause problems.

SGB & Other Therapies

The Stellate Ganglion Block (SGB) is just one part of the healing journey. When someone feels out of control in their body or alone in a room full of people, SGB has the potential to restore the sense of calm and clarity they crave. And when paired with skilled therapy, SGB can be life-changing.

Mental health care providers can help maximize and maintain SGB’s positive impacts. For example, when someone isn’t distracted by their symptoms, it becomes easier to be fully present during therapy sessions and thus integrate takeaways into everyday life.

We think that those who received SGB by Stella put it best:

“I’m not as fearful or panicked as I was, but I’m still working through my anxiety with my therapist. She has hope for me and feels like I have made a good leap in my process.” 

“I feel like [SGB] has been a HUGE turning point in my healing. It’s allowed me to start a spiritual 12-step program that requires intense vulnerability in a group setting. I can feel appropriate emotions but not get triggered by others’ trauma. This is a first.”

If you’re a mental healthcare provider looking to join Stella’s mission to end the needless suffering caused by emotional trauma, please find more information about how to collaborate with Stella here.

How To Learn More

You can read up on this breakthrough treatment on the How SGB Works page of our website.

Call our Care Advocates at (908) 928-4086 to schedule your initial consultation with a Psychiatric Mental Health Nurse Practitioner. You’ll work together to determine if SGB is the next right step in your healing journey.

  1. Alkire, M.T., Hollifield, M., Khoshsar, R., Nguyen, L., Alley, S. R., and Reist, C. (2015). Neuroimaging suggests that stellate ganglion block improves post-traumatic stress disorder (PTSD) through an amygdala mediated mechanism. Presented at the Anesthesiology Annual Meeting, October 24, 2015.
  2. Eugene G.LipovaJaydeep R.JoshiaSarahSandersaKonstantin V.Slavinb A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD) https://www.sciencedirect.com/science/article/abs/pii/S0306987709000413
  3. U.S. Department of Veterans Affairs. (2018, September 13). How Common is PTSD in Adults? U.S. Department of Veterans Affairs. Retrieved February 2, 2022, from https://www.ptsd.va.gov/understand/common/common_adults.asp 
  4. Lipov, E. G., Jacobs, R., Springer, S., Candido, K. D., & Knezevic, N. N. (2022). Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis. Pain Physician, 25(1), 77-85. Available from: https://www.painphysicianjournal.com/current/pdf?article=NzM5Nw%3D%3D 
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