Stellate Ganglion Block Case Report | January 3rd, 2019
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Taina Danahy, BrainCore Neurofeedback Provider
Chronic Anxiety & Post-Traumatic Stress Disorder (PTSD)
The patient reported having PTSD symptoms as a result of experiencing multiple life-threatening events, including being attacked by a rocket-propelled grenade and two improvised explosive devises, during his time spent serving as an infantryman in the United States Army. He stated he consumed alcohol every night to help him fall asleep, and felt constantly stressed and worried while awake. He said he was motivated to seek help and find treatment for his PTSD because of his 3-year-old daughter.
The patient’s quantitative electroencephalogram (qEEG) ), given by Danahy, the BrainTrain specialist at JWP, showed that his brain was 75% consumed in a stress and anxiety state. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient ; his pre-stellate score was 40.
After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment, aimed at relieving his chronic anxiety and stress.
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 artery , using a high-resolution ultrasound . 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, 9 mL 0.5% Ropivacaine was injected by NP Bender 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.
Immediately following the treatment, the patient reported feeling incredible relief.
At his follow-up, the patient stated feeling incredibly happy since the treatment. He noted that his reflexes had dramatically improved, an enhanced ability to perform his profession and, most importantly, an increased ability to cultivate his relationship with his daughter.
Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block
In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 42% 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 ulrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.