CASE 2

Title
Stellate Ganglion Block Case Report | August 29, 2016
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Carol Hanselman, RNP

Diagnosis
Post-Traumatic Stress Disorder

Introduction
On August 3, 2016, patient presented to the clinic for a stellate ganglion block procedure. Patient reports that she was divorced 10 days ago, and was married for 3 years before that, and it was an emotionally abusive marriage. When in college, she was sexually-assaulted multiple times, raped one time, and received an abortion. She had four physically abusive boyfriends. She had early history of epilepsy as a child that has resolved. She has felt abandoned by friends who have not been loyal throughout these hardships in her life. Currently, the patient feels like she is choking in her throat. She has several panic attacks and episodes of crying every week. She is very sensitive. She is sleeping poorly and starts crying for long periods of time. She feels unlike herself, when five years ago she would be very motivated, and she would not be affected by other peoples’ criticisms and comments. She says it is hard to get up out of bed and do her job. From the stellate block, she desires to be less sensitive and feel that she no longer has a choking sensation. She wants the flashbacks from her marriage to go away. After discussing the procedure with our staff, the patient requested to receive the treatment.

Treatment
Needle approach planned by Dr. Shawn Tierney, who examined the anatomy around Chassaignac’s tubercle and the path of the vertebral artery, which is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle. Dr. Tierney also confirmed the location of the fascial plane between the longus capitus and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. Through ultrasound guidance, 7cc 0.5% Ropivacaine was injected by Dr. Jeremiah Maloney, Anesthesiologist, around the stellate ganglion on the right side of the neck. Anticipated Horner’s syndrome was achieved within 5 minutes of completion of the block. Patient was observed for any post procedural complications and none were noted.

Follow-up
The day after the procedure, the patient appeared so alive and happy that she was hardly recognizable by the observing anesthesiologist. Patient reported no adverse effects from the procedure. The patient’s score on the PCL was 57 prior to the Stellate Ganglion Block on August 3, 2016, and is 46 after the Stellate Ganglion Block on August 28, 2016. She reports that she only had one panic attack in the past three weeks post-procedure, which is a significant improvement. She is no longer sensitive to the words spoken by her ex-husband. She is able to see truth in situations. She has become inspired to start an entrepreneurial venture in her field and is writing the business plan already. She notices that she is able to sleep through the night, and she is no longer having flashbacks from her marriage. She feels that she is in control of her emotions, and she is no longer controlled by her exhusband’s words. The choking sensation is significantly reduced. On October 25, 2016, on the patient’s 35th birthday, she reported feeling joyful, with ability to make clear decisions with confidence, and reduced guilt from the divorce.

Results
Figure 1. Patient’s Self-Reported PCL-C, before and after the Stellate Ganglion Block