CASE 3

Title
Stellate Ganglion Block Case Report | August 23, 2018
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Carol Hanselman, RNP

Diagnosis
Post-Traumatic Stress Disorder

Intro
On July 16th 2018, patient presented to the clinic for a stellate ganglion block procedure.Patient reports that he has PTSD, from his experiences in the military. In his first deployment in Iraq, he was not only a victim of a bus explosion, but also was sexually molested by the military. In his third deployment, his base was attacked, he was thrown offthe chair and his friend was severely injured. Overall, his PTSD had been causing him significant amount of fatigue, depression, anxiety, insomnia, chronic pain, irritability, nightmares, flashbacks, suicidal thoughts and loss of interest in most things.

His marriage had been strained and he had a lack of motivation to accomplish his goals ofone day becoming a chaplain for the military.

After discussing the procedure with our staff, the patient requested to receive thetreatment.

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 C6anterior tubercle. Dr. Tierney also confirmed the location of the fascial plane between thelongus capitus and longus coli, just anterior to Chassaignac’s tubercle, as well as the path ofthe 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. AnticipatedHorner’s syndrome was achieved within 5 minutes of completion of the block. Patient wasobserved for any post procedural complications and none were noted.

Follow-up
Patient reports feeling an incredible relief from the stellate ganglion block. He reported thathis suicidal ideations had completely disappeared since the block, and he also reported thathe was no longer hyper-reactive to triggers that previously set him off. He was able to feelgenuine happiness for the first time in years. He used to have many angry outbursts, andhave difficulty falling and staying asleep, and these symptoms have almost completelyresolved since the stellate.

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