Advances in the clinical application of stellate ganglion block for non-pain indications.

Background: Stellate ganglion block (SGB) is a peripheral nerve block technique involving injection of local anesthetics and/or steroids near the stellate ganglion. Traditionally used for pain-related syndromes, SGB has recently expanded into non-pain fields with the advancement of ultrasound guidance, showing therapeutic potential in arrhythmias, menopausal hot flashes, psychiatric disorders, cerebrovascular diseases, insomnia, and COVID-19 sequelae. Objective: To review the current evidence on SGB applications in non-pain conditions, evaluate its therapeutic efficacy and safety across different diseases, elucidate underlying mechanisms, and identify research gaps and future directions. Methods: This narrative review synthesized data from published literature including case reports, cohort studies, and randomized controlled trials (RCTs) on SGB in non-pain conditions. Studies were analyzed based on disease categories, with focus on mechanism of action, clinical outcomes, and safety profiles. Results: Stellate ganglion block demonstrates therapeutic effects across six domains: (1) Ventricular arrhythmias: In a multicenter observational study of 131 patients (the STAR study), 92% (106/115) of patients with treatable arrhythmic episodes achieved a ≥50% reduction in arrhythmia burden within 12 h via sympathetic blockade and QT dispersion reduction; (2) Menopausal hot flashes: Significant reduction in frequency through modulation of thermoregulatory pathways; (3) Insomnia: Improved sleep quality via autonomic balance restoration; (4) Cerebrovascular diseases: Enhanced cerebral perfusion and cognitive function; (5) Post-Traumatic Stress Disorder (PTSD): Case series have reported response rates of 70%-75% via inhibition of locus coeruleus-norepinephrine circuits; randomized evidence is mixed-a small early trial found no benefit over sham, whereas the subsequent multicenter randomized controlled trial ( Conclusion: Stellate ganglion block has become an important intervention for autonomic dysfunction in non-pain conditions through sympathetic blockade, neuroendocrine modulation, and anti-inflammatory effects. Although ultrasound guidance has improved safety, evidence remains limited by small RCTs, heterogeneous protocols, and observational designs. Rigorous multicenter RCTs are needed to confirm efficacy, define patient selection, and standardize protocols. Further research should investigate central regulatory mechanisms and long-term neuroplasticity to advance SGB from empirical therapy to precision intervention.