Ultrasound-Guided Stellate Ganglion Blocks

How SGBs Work in the Body

The stellate ganglion is a collection of nerves that influence blood flow, pain perception, and the fight-or-flight response. In PTSD, this nerve cluster is believed to affect key brain structures like the amygdala, which plays a central role in processing fear and emotional memory. By modulating activity in these circuits, SGB may help reduce the intensity and frequency of trauma-related symptoms.

In CRPS, abnormal sympathetic signaling causes exaggerated pain responses, swelling, and color changes in the affected limb. Therefore, stellate ganglion blocks disrupt this cycle by quieting the sympathetic nerves and resetting the overactive responses. For many patients, this break in the cycle brings noticeable relief.

Consequently, the procedure has gained traction as part of comprehensive pain and psychiatric treatment programs.

SGBs for Complex Regional Pain Syndrome

CRPS is a notoriously difficult condition characterized by chronic, severe pain often following trauma or surgery. According to the American Academy of Pain Medicine guidelines, sympathetic nerve blocks like SGBs are recommended for CRPS, especially when the pain is sympathetically maintained.

Recent meta-analyses and clinical guidelines support the use of stellate ganglion blocks as part of a multimodal treatment strategy, often in combination with medications, physical therapy, occupational therapy, or psychological support. For example, a systematic review in Pain Physician (2024) confirmed that SGB therapy significantly reduces pain intensity in CRPS patients, with minimal adverse events reported.

In a retrospective study of over 800 ultrasound-guided SGBs performed for CRPS and other neuropathic conditions, most patients experienced meaningful reductions in pain. Additionally, the data suggest that repeat blocks, sometimes in a series of two or more, can further increase benefit.

As such, SGBs represent an important component of the CRPS treatment algorithm.

Stellate Ganglion Blocks for PTSD

Emerging research has highlighted SGBs as an effective option for PTSD. A randomized clinical trial published in JAMA Psychiatry found that patients receiving SGB treatment experienced significantly greater reductions in PTSD symptom severity than those receiving sham treatments.

SGBs appear particularly useful in reducing hypervigilance, anxiety, and re-experiencing symptoms. While the exact mechanism is still under investigation, imaging studies suggest SGB may modulate amygdala hyperactivity—the brain region associated with fear and trauma responses.

Moreover, behavioral health clinicians increasingly recommend SGBs as a useful adjunct to trauma-focused therapy. These blocks appear especially effective for treatment-resistant PTSD, where traditional medications and psychotherapy may fall short.

In summary, SGB offers a promising neurobiological tool to complement psychological treatment.

Why Ultrasound Guidance Matters

Ultrasound guidance offers real-time visualization of anatomical structures during the procedure, dramatically improving precision and safety.

Key advantages include:

• Reduced risk of vascular injury

• Increased accuracy of anesthetic placement

• Lower incidence of complications

• No radiation exposure compared to fluoroscopy

Studies show ultrasound-guided SGBs are at least as effective as fluoroscopy-guided techniques, if not superior. A cadaveric study published in Pain Medicine (2021) confirmed ultrasound guidance offered comparable, if not improved, accuracy with reduced risk.

Therefore, ultrasound guidance should be the standard of care for this procedure.

Common Side Effects and Complications

While generally well-tolerated, SGBs do carry some risks:

Common side effects include:

• Hoarseness (3.9%)

• Difficulty swallowing (3.4%)

• Temporary Horner’s syndrome (ptosis, miosis, anhidrosis)

• Mild dizziness or flushing

Rare but serious complications include:

• Vascular injury

• Hematoma

• Pneumothorax

• Intravascular injection leading to seizures or neurologic events

Fortunately, ultrasound guidance greatly reduces these risks. The overall complication rate when using ultrasound is very low, making this a safe procedure when performed by experienced providers.

As always, proper patient selection and technique are critical to minimizing risks.

Conditions Beyond CRPS and PTSD

Stellate ganglion blocks may also help with:

• Phantom limb pain – Small case series and early clinical reports suggest benefit, though larger trials are needed

• Refractory angina

• Hot flashes and vasomotor instability (especially in breast cancer survivors)

• Migraines and facial pain

Research in these areas is ongoing. Nevertheless, early studies show promise.

For this reason, SGB is being explored across a broad spectrum of sympathetically mediated conditions.

How Often Are Stellate Ganglion Blocks Performed?

Once considered a niche technique, SGBs are now increasingly common in pain and behavioral health practices. Patients often undergo one to three blocks to determine effectiveness. In some cases, maintenance blocks are scheduled if benefits wane over time.

Importantly, patients with CRPS or PTSD often report relief within 30 minutes to 24 hours of treatment. When successful, many describe it as a “reset” for their nervous system.

Accordingly, the use of SGB is expanding as awareness and access improve.

Who Is a Good Candidate for SGB?

You may benefit from stellate ganglion blocks if you have:

• CRPS of the upper limb

• PTSD not fully responding to therapy or medication

• Severe sympathetic pain disorders

• Refractory neuropathic pain

Your provider will evaluate your medical history, current symptoms, and response to prior therapies before recommending the procedure.

Thus, individualized evaluation is essential for optimal outcomes.

What to Expect During the Procedure

Key Expectations for Patients

Procedure Time: 10–20 minutes
Recovery: Most patients return to normal activities the next day. Temporary side effects like voice changes or eyelid droop may occur.
Monitoring: Patients are observed for 30–60 minutes after the procedure.
Adjunct Care: We often pair the procedure with physical therapy for CRPS or psychotherapy for PTSD to support long-term results.

SGBs are outpatient procedures performed with care and precision. We begin by cleaning the skin to reduce the risk of infection and conducting a time-out procedure for safety. After anesthetizing the skin with lidocaine, we use ultrasound to visualize the neck anatomy in real time. The needle is carefully advanced under ultrasound guidance, and the local anesthetic is injected around the stellate ganglion.

Afterward, patients are monitored and typically return to daily activities the following day. In addition, we often coordinate follow-up care with physical therapists for CRPS or mental health providers for PTSD to enhance outcomes.

Together, these steps help ensure safety, efficacy, and continuity of care.

Conclusion

Stellate ganglion blocks are an effective and well-tolerated treatment for CRPS and PTSD. With ultrasound guidance, the procedure becomes even safer and more precise.

If you’re struggling with unresolved nerve pain or trauma symptoms, Red Butte Pain Solutions can help. We offer advanced diagnostic tools and treatment options—including ultrasound-guided stellate ganglion blocks—to help you feel like yourself again.

Schedule now or call us at 602-633-4334 to explore whether SGB is right for you.