Use of Stellate Ganglion Block for Treatment-Resistant Post-Traumatic Stress Disorder: A Case Report

Abstract: PTSD is defined as a group of symptoms which include intrusive flashbacks and re-experiences of a traumatic event, avoidance of any trauma related stimuli, negative changes in moods and increased arousal and reactivity to one’s environment. It is a very common diagnosis amongst veterans in the United States. The first line treatments for PTSD include psychotherapy, pharmacotherapy, or a combination of both. Medications used to treat PTSD include SSRI’s and SNRI’s such as venlafaxine and addition of antipsychotics in severe disease. The annual remission rate in individuals diagnosed with PTSD is 30-40% suggesting room for improvement in the treatment of this disease . Multiple case reports have suggested benefits of stellate ganglion blocks in patients who do not respond to traditional first line therapy. A recent randomized control trial showed clinically significant improvement in a group of 24 veterans 8 weeks after an injection. These participants received 10mL of 0.5% Ropivacaine in their right stellate ganglion followed by a repeat on the left side after 2 weeks. Outcomes showed clinically significant improvement in anxiety, depression, pain and mental functioning. The individuals in the study had improved symptoms which lasted 3-6 months on average, then requiring additional injections if warranted. Further research is necessary to determine the efficacy and timing of repeated blocks. Though adverse events of the stellate ganglion block are rare especially if the block is performed with ultrasound guidance, they can include infection, nerve injury, spinal anesthesia, and local anesthetic systemic toxicity.Short Description: Stellate ganglion injections have been used to manage sympathetically derived pain in patients. New research has been focused on using the SGB's for treatment of PTSD in individuals not responding to the traditional treatment approaches which include psychotherapy and pharmacotherapy. Early studies have shown promising findings in the use of SGB's in patients resistant to traditional treatment approaches.Name of Sponsoring Organization(s): N/A