Stellate Ganglion Block Case Report | August 2nd 2016
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Carol Hanselman, RNP
Post-Traumatic Stress Disorder (PTSD)
The patient reported suffering daily from the residual effects of a traumatic brain injury he sustained with serving in the military. He felt fatigued, and frequently experienced insomnia, panic attacks and anxiety. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-stellate score was 78. After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment, with the understanding that the likelihood of success was less certain given the confounding factors of residual intracranial pathologies.
The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam 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.
Under ultrasound guidance, 7 mL 0.5% Ropivacaine was injected by Dr. Maloney around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.
Two months after the treatment, the patient reported being unsure if the SGB worked for him. He stated that he is still paranoid that his children are in danger, and his anger can flare up in an instant. He is getting more full nights of sleep, but he still experiences insomnia. However, he noted that he hasn’t had any adverse effects from the procedure.
Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block.
In conclusion, it was found that the Stellate Ganglion Block injection was a moderately effective solution to the patient’s PTSD symptoms, as demonstrated by the 26% reduction in the patient’s PCL score.
References: Mulvaney, Sean W., MD; Lynch, James H., MD; Kotwal, Russ S., MD, MPH. (2015). Clinical Guidelines for Stellate Ganglion Block to Treat Anxiety Associated with Posttraumatic Stress Disorder. Journal of Special Operations Medicine, Volume 15 (2), 76-82.
The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment
The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.