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.

Efficacy of Stellate Ganglion Block in Treating Long-Term COVID-19-Related Olfactory and Gustatory Dysfunction: A Case Series

“…SGB involves the administration of a local anesthetic, such as ropivacaine, to the stellate ganglion, a collection of sympathetic nerves located anterior to the neck of the first rib. This procedure has been used to treat various pain conditions and has shown promise in alleviating post-viral anosmia and ageusia [4,5]. This case series aims to add to the growing body of evidence on the efficacy of SGB in treating olfactory and gustatory dysfunction in patients with long-term COVID-19 symptoms.…”

A pilot study of stellate ganglion block paired with exposure therapy: Feasibility and acceptability in combat veterans with posttraumatic stress disorder.

“…SGB is thought to decrease nerve growth factor (NGF) and the associated release of norepinephrine, leading to a “reset” of the sympathetic chain (Lipov et al, 2012). Elevated levels of NGF, related to acute or chronic stress, cause increased “sympathetic sprouting,” leading to a systemic increase in norepinephrine (Kirkpatrick et al, 2023).…”

“…SGB is thought to decrease nerve growth factor (NGF) and the associated release of norepinephrine, leading to a "reset" of the sympathetic chain (Lipov et al, 2012). Elevated levels of NGF, related to acute or chronic stress, cause increased "sympathetic sprouting," leading to a systemic increase in norepinephrine (Kirkpatrick et al, 2023). This is significant as hyperarousal symptoms are a hallmark feature of PTSD and greatly contribute to functional impairment as veterans learn to avoid anxiety-provoking situations, significantly limiting their usual activities.…”

Use of Stellate Ganglion Block to Treat Anosmia and Dysgeusia Associated With COVID-19: A Narrative Review

“…The stellate ganglion is a group of SNS cell bodies located between the C6 and C7 vertebrae, directly anterior to the tubercle between the C6 and C7 vertebrae (Figure 1). 20 Present in about 80% of the population, it is formed as the inferior cervical ganglion and the first thoracic ganglion fuse, carrying sympathetic innervation to the head, neck, upper trunk, and upper extremities 21. In populations lacking fusion of these ganglia, the stellate ganglion refers to the inferior cervical ganglion that resides next to the C7 anterior tubercle.…”