Stellate Ganglion Block for Post-traumatic Stress Disorder: A Comprehensive Review of Evidence, Technique Considerations and Symptom Outcomes in Military and Non-Military Patients.

purpose of reviewPost-traumatic stress disorder (PTSD) is a psychiatric disorder which is defined by four symptom clusters of intrusive re-experiencing, avoidance, negative mood/cognitive changes, and hyperarousal. This pathway is mediated by a dysregulation in the amygdala-hippocampus-medial prefrontal cortex circuit resulting in an abnormal threat processing and other symptoms. Stellate ganglion blocks (SGB) are largely supported in a review of the current literature. The objective of this review is to synthesize available evidence and extrapolate findings to identify patient and symptom profiles most likely to benefit, as well as technique variations that may optimize clinical outcomes. RECENT

findingsBilateral SGBs or blocks in conjunction with a superior cervical ganglion block (SCGB) have been studied and appear safe and effective but may not necessarily offer superior efficacy or durability of response, although may be considered in patients that fail a right sided block. In observations across studies, hyperarousal symptoms tended to benefit most and re-experiencing the least. The effects are positive in both mild-moderate and severe cases, but severe cases may benefit more. The block has been shown to be effective in both military and non-military patients across all trauma types. The practitioner should perform the block using ultrasound or fluoroscopy based on their preference, and perhaps at least 6 mL of local anesthetic should be used. The block can be performed bilaterally (after 24 h to avoid bilateral recurrent laryngeal block) or in conjunction with a superior cervical ganglion block (SCGB), which has shown to be effective and safe, however not necessarily more effective than a single right sided block. There may be benefit in patients that fail a right-side block. The effects of a SGB on PTSD may last up to 3–6 months and can be repeated with efficacy. Ideally, PTSD should be treated in a multimodal approach using concurrent therapy and pharmacologic treatment. Further high-quality studies are needed to provide further data and evidence to support these observations.