Stellate Ganglion Block (SGB) for PTSD: What You Need to Know – Evidence, Procedure, Success and Safety

Understanding SGB for PTSD

Post-Traumatic Stress Disorder (PTSD) can affect both the mind and body. While therapy and medication remain first-line treatments, many people continue to experience symptoms like anxiety, hypervigilance, and sleep disturbances. For some, the body’s “fight-or-flight” system remains locked in overdrive even long after trauma has passed.

This is where the Stellate Ganglion Block (SGB) comes in. SGB is a minimally invasive injection that targets part of the sympathetic nervous system in the neck to help calm this overactivity. Though it’s considered off-label for PTSD, growing evidence and clinical experience show it can help reduce hyperarousal, improve sleep, and restore a sense of calm.

At Interventional Orthopedics of Washington (IOW) in Bellevue, WA, SGB is performed with real-time image guidance for precision and safety. Below, you’ll learn how it works, what to expect, and whether it may be the right option for you.

Quick Things to Know

• What SGB is: A targeted injection that helps reset an overactive “fight-or-flight” response by temporarily numbing the stellate ganglion, a cluster of nerves in the lower neck.

• Why it may help: By reducing sympathetic overactivity, SGB can ease symptoms like anxiety, sleep disruption, and exaggerated startle responses.

• Off-label but promising: While not FDA-approved for PTSD, clinical reports show significant improvement for some patients.

• Adjunctive treatment: SGB works best when combined with therapy, medication, and lifestyle care.

• Duration: Relief may last weeks to months, and some patients schedule booster injections as needed.

What Is SGB for PTSD?

How It Targets The Stress Response

The stellate ganglion is part of the sympathetic nervous system, responsible for regulating the body’s “fight-or-flight” reactions. In PTSD, this system can become stuck in a constant state of activation.

SGB temporarily blocks the transmission of stress signals by numbing the stellate ganglion with a local anesthetic. This interruption can help the brain and body reset, allowing the parasympathetic (“rest-and-digest”) system to regain balance.

Many patients report a calmer heart rate, fewer startle responses, and better sleep within days of treatment.

Why Image Guidance Matters

Safety and precision are essential. At IOW, every SGB procedure is performed under ultrasound guidance, allowing the physician to visualize nearby blood vessels, nerves, and structures in real time. This minimizes risk and ensures the medication is placed at the optimal level for effectiveness.

What Is the Success Rate of Stellate Ganglion Block for PTSD?

What Recent Studies Show

Clinical experience and early research suggest that stellate ganglion block (SGB) can significantly reduce PTSD symptoms in select patients. Improvements are most often seen in hyperarousal, anxiety, and sleep patterns.

In the first multisite randomized clinical trial of SGB for PTSD, 113 active-duty service members were randomized to receive two right-sided SGB injections versus a sham procedure, given two weeks apart. At eight weeks, the SGB group improved by a mean of –12.6 points on the CAPS-5 compared with –6.1 points in the sham group, a difference that meets the threshold for clinically meaningful change (Rae Olmsted et al., 2020).

A quick note: CAPS-5 is a standard scale used to measure PTSD symptom severity.

A 2023 narrative review examining SGB as an adjunctive treatment across several sympathetically driven conditions noted that although the evidence base is still limited, studies consistently report meaningful symptom relief for a subset of patients. Improvements were most often seen in hyperarousal, anxiety, and symptoms tied to sympathetic overactivation (Kirkpatrick et al., 2023).

Retrospective data also suggest that some individuals who do not respond sufficiently to a standard right-sided block may still benefit from a left-sided SGB. A review of 205 patients found that many right-sided non-responders experienced significant improvement after receiving a left-sided block (Mulvaney et al., 2022).

While these findings are encouraging, outcomes vary between individuals, and ongoing research is focused on clarifying long-term benefit, ideal protocols, and how best to integrate SGB into comprehensive PTSD care.

Key References

• Rae Olmsted KL, Bartoszek M, Mulvaney S, et al. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry. 2020. PubMed: https://pubmed.ncbi.nlm.nih.gov/31693083.

• Kirkpatrick K, Khan MH, Deng Y, Shah KB. A Review of Stellate Ganglion Block as an Adjunctive Treatment Modality. Cureus. 2023. PubMed: https://pmc.ncbi.nlm.nih.gov/articles/PMC10029323.

• Mulvaney SW, Lynch JH, Curtis KE, Ibrahim TS. The Successful Use of Left-sided Stellate Ganglion Block in Patients That Fail to Respond to Right-sided Stellate Ganglion Block for the Treatment of Post-traumatic Stress Disorder Symptoms: A Retrospective Analysis of 205 Patients. Military Medicine. 2022. PubMed: https://pubmed.ncbi.nlm.nih.gov/33580677.

How Long Results May Last

Many patients notice relief that lasts several weeks to a few months. The duration varies based on individual factors, baseline symptom severity, and how the nervous system responds to the block.

If symptoms return, repeat or “booster” injections can be scheduled. Follow-up blocks are often spaced weeks to months apart and may help maintain a calmer baseline state over time.

Some patients experience meaningful improvement after only one session, while others benefit from a series of treatments as part of their broader PTSD care plan.

SGB Procedure for PTSD: What to Expect at IOW

Before Your Visit

Your physician will review your medical history, current medications, and PTSD symptoms. You’ll discuss the procedure, its potential benefits, and what to expect afterward.

Most patients are asked to avoid blood-thinning medications beforehand.

During the Visit

• You’ll lie comfortably on your back.

• The area on your neck is cleaned and numbed with a local anesthetic.

• Using ultrasound guidance, the physician carefully places a small amount of medication near the stellate ganglion (usually at the C6 or C7 vertebra).

• The procedure takes about 15–20 minutes, with total visit time under an hour.

• Most patients start with the right side, and the left may be considered later if needed.

Aftercare and Same-Day Recovery

Common temporary sensations include a warm arm, droopy eyelid, or mild hoarseness. All signs that the block is working. These effects usually fade within a few hours. Patients are typically cleared to return to light activity the same day, though a ride home is recommended.

What Are the Risks of Stellate Ganglion Block for PTSD?

Common and Temporary Effects

• Mild hoarseness

• Red or watery eye

• Lump-in-throat sensation

• Temporary arm warmth or heaviness

These effects are expected and resolved within hours.

Uncommon But Serious Risks

• Bleeding or bruising

• Infection at the injection site

• Nerve injury or vascular puncture

• Pneumothorax (rare)

• Local anesthetic toxicity (extremely rare with ultrasound guidance)

How IOW Reduces Risk

At IOW, every SGB is performed with real-time ultrasound, sterile technique, and safety checks before and after injection. This precision-based approach ensures accuracy while minimizing complications.

Who Is a Good Candidate for SGB?

Good Fit

You may be a good candidate if you:

• Have PTSD with hyperarousal, anxiety, or sleep issues

• Have tried therapy or medication but still experience strong physical symptoms

• Want to improve emotional regulation and stress response naturally

Not a Good Fit

SGB may not be appropriate for individuals with:

• Active infection at the injection site

• Bleeding disorders or anticoagulant use

• Recent heart attack or heart conduction block

• Severe asthma or COPD

• Severe glaucoma

A consultation ensures that every patient’s care plan is tailored for safety and suitability.

How SGB Compares to Other PTSD Options

Works with Therapy and Medications

SGB is not meant to replace therapy or medication. It’s designed to complement them. By reducing the body’s hyperarousal, many patients find it easier to participate in trauma-focused therapy or EMDR and experience improved emotional regulation.

What Medication Is Not Recommended for PTSD

Major treatment guidelines do not recommend benzodiazepines (like Xanax or Ativan) for PTSD due to potential dependence and interference with trauma processing. Instead, evidence-based care focuses on therapy, SSRIs, and adjunctive treatments like SGB.

IOW’s Approach and Why Technique Matters

Image-Guided Precision

At Interventional Orthopedics of Washington, all injections are performed by fellowship-trained physicians using ultrasound or fluoroscopic guidance. This ensures safe, accurate delivery of the anesthetic and consistent outcomes.

Measurable Progress

Patients are monitored before and after treatment using standardized symptom scales and sleep metrics to track improvement and guide follow-up care.

What We Still Do Not Know

SGB for PTSD continues to evolve as an emerging therapy. Research is ongoing to determine:

• How long results can last

• The ideal timing between treatments

• Which patients benefit most

Early findings are encouraging, but larger studies will help refine its role in PTSD care.

Ready to Find Out if SGB Is Right for You?

If you’re living with PTSD and want to explore safe, non-surgical options for symptom relief, SGB may be worth discussing.

At Interventional Orthopedics of Washington in Bellevue, WA, our team combines advanced image-guided techniques with compassionate, individualized care.

Schedule a consultation today to see if SGB can help calm your nervous system and restore balance to your life.