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

Abstract

Olfactory and gustatory dysfunction, including anosmia, parosmia, ageusia, and dysgeusia, are common long-term symptoms of coronavirus disease 2019 (COVID-19) infection. These symptoms can have a severe impact on quality of life of a patient, including psychological well-being. Stellate ganglion block (SGB) has recently been explored as a potential therapeutic intervention for these symptoms. In this case series, we present six patients with long-term COVID-19 symptoms and we detail how their symptoms evolved after an SGB. All SGB were performed under ultrasound guidance by the same physician. Patients had a right SGB during the initial visit, followed by a left SGB at a subsequent visit. All but one patient reported improvements in olfaction and gustation after the SGB. Our findings suggest that SGB may be a promising therapeutic intervention for patients with olfactory and gustatory dysfunction related to long-term COVID-19 symptoms. Further research is needed to confirm these findings and to explore the optimal treatment protocol.

Stellate ganglion block for treating post‐COVID‐19 parosmia

“…Prior case reports of SGB report stepwise improvements in parosmia from unilateral to bilateral, sometimes with complete resolution of symptoms after completing bilateral SGB 27,28,32 . In this study, improvements in subjective parosmia severity scores were statistically significant from pre‐SGB to SGB1, and from pre‐SGB to SGB2 in the overall and BL cohort.…”

“…11,14 Prior case reports of SGB report stepwise improvements in parosmia from unilateral to bilateral, sometimes with complete resolution of symptoms after completing bilateral SGB. 27,28,32 In this study, improvements in subjective parosmia severity scores were statistically significant from pre-SGB to SGB1, and from pre-SGB to SGB2 in the overall and BL cohort. While the difference in severity scores from SGB1 to SGB2 was not statistically significant in the overall cohort, the difference was indeed significant in the BL cohort, which may inform the utility of BL SGB in addressing patient symptoms.…”

“…It may be administered by either ultrasound-or CT-guided injection of a local anesthetic to the cervical sympathetic ganglion located near the transverse process of C6. 28 In case reports of SGB for parosmia, patients have reported rapid improvement in parosmia symptoms within minutes after the procedure. 11,14 This timely response to sympathetic blockade suggests a central component of dysautonomia is likely involved in post-COVID-19 parosmia.…”

“…SGB is hypothesized to treat parosmia symptoms through a sympathetic blockade. It may be administered by either ultrasound‐ or CT‐guided injection of a local anesthetic to the cervical sympathetic ganglion located near the transverse process of C6 28 . In case reports of SGB for parosmia, patients have reported rapid improvement in parosmia symptoms within minutes after the procedure 11,14 .…”

Long‐term olfactory loss post‐COVID‐19: Pathobiology and potential therapeutic strategies

“…Stellate ganglion nerve blocks with local anesthetics, which have previously been used in the context of posttraumatic stress disorder, migraine, and complex regional pain syndrome to mitigate dysautonomia, have been proposed as a long‐COVID hyposmia or parosmia treatment, largely based on case reports 44,49 . The injection is performed by anesthesiologists using ultrasound guidance, usually infiltrating lidocaine.…”