(Kiosk 5) A Series of Stellate Ganglion Blocks for the Management of Post-traumatic Stress Disorder (PTSD)

Case Diagnosis: Post-Traumatic Stress Disorder

Case Description or Program Description: The authors present a 37-year-old male military veteran with a past medical history of PTSD. He suffers from symptoms such as flashbacks, anxiety attacks, and insomnia. The patient had exhausted multiple treatment modalities. In our office, he received three stellate ganglion blocks (SGB), each two weeks apart. Each SGB was administered on the right side of the C6 transverse process. The injectate for each shot was a combination of bupivicaine, dexamethasone and normal saline.

Setting: Pain Management Private Practice

Assessment/Results: The patient reported a reduction in all aforementioned PTSD-related symptoms after each shot, with most notable improvement after his third series. Regarding specific symptoms, he reported the most significant relief of his anxiety attacks and insomnia. He reported no complications during or post-interventions.

Discussion (relevance): Trauma-focused psychotherapy and Selective Serotonin Reuptake Inhibitors (SSRIs) are the current first-line treatment for patients suffering from post-traumatic stress disorder (PTSD). The symptoms of PTSD are thought to be caused by an overactive sympathetic nervous system and the body’s inability to regulate this response. This sympathetic overdrive results in a variety of symptoms such as anxiety, insomnia, negative emotions, mood disorders, and impaired cognition. The stellate ganglion is a group of sympathetic nerves that result from a fusion of the inferior cervical and first thoracic sympathetic ganglions. Recent studies have shown that SGBs can reduce PTSD-related symptoms such as anxiety, flashbacks, distress and depression. This procedure is completed via fluoroscopy or ultrasound guidance and targets the stellate ganglion at the level of C6 or C7 on the right. The injectate used is typically a local anesthetic and may be combined with a steroid.

Conclusions: Stellate ganglion blocks are a promising adjunct therapy for PTSD. Further investigation of this intervention is required to establish its potential efficacy and utility in specific populations suffering from PTSD.