Quick answer : A stellate ganglion block (SGB) is a procedure in which a local anesthetic is injected around a cluster of sympathetic nerves in the neck, temporarily quieting the part of the nervous system responsible for fight-or-flight signaling. For patients with PTSD, anxiety, and certain forms of depression, this can rapidly reduce hyperarousal symptoms including hypervigilance, sleep disruption, and chronic sympathetic overdrive.
Research into SGB for PTSD has grown over the past several years.
A randomized controlled trial published in JAMA Psychiatry in 2020 examined stellate ganglion block as a treatment for PTSD. The study found greater reductions in PTSD symptom severity in the SGB group than in the control group after two weeks. Researchers continued to observe improvements during follow-up.
These findings helped increase interest in SGB as a potential treatment for PTSD, particularly among military and veteran populations.
Researchers continue to study exactly how SGB produces its effects.
One theory focuses on the sympathetic nervous system and its role in chronic hyperarousal. Temporarily blocking sympathetic signaling may alter the body’s threat-response state and give the nervous system an opportunity to recalibrate.
Other research has explored possible changes involving nerve growth factor, the amygdala, and other brain regions involved in stress and threat processing.
These mechanisms remain areas of investigation. The clinical evidence for PTSD is stronger than the evidence for many other conditions.
Research into SGB for depression and other conditions remains more limited. Some studies suggest that SGB may influence autonomic and central nervous system activity beyond the immediate injection site. However, researchers need more evidence before we can draw firm conclusions about these effects.
At Seaside Ketamine, we consider SGB particularly relevant for certain patients with prominent PTSD or autonomic symptoms.
Patients with PTSD may experience significant hyperarousal, including:
Hypervigilance
An exaggerated startle response
Sleep disruption
Racing thoughts
Difficulty feeling calm in objectively safe situations
Research on SGB has focused heavily on PTSD, including military and veteran populations.
Some patients experience a strong physical component to their anxiety or PTSD.
Symptoms may include:
Racing heart
Sweating
Feeling constantly “wired”
Difficulty calming down
Persistent physical tension
For these patients, addressing sympathetic nervous system activity may be part of a broader treatment strategy.
Researchers and clinicians have also explored SGB for post-viral symptoms and autonomic dysfunction associated with Long COVID.
This remains an emerging area of research. Patients with Long COVID or POTS-like symptoms should receive a thorough medical evaluation before considering SGB.
Some patients do not achieve adequate relief from medication or therapy. Others may not respond sufficiently to ketamine.
Because SGB works through a different mechanism, a lack of response to another treatment does not automatically rule out SGB.
However, previous treatment response alone cannot predict whether an individual patient will benefit. A physician needs to evaluate the patient’s symptoms, medical history, and overall treatment plan.
The word “injection” combined with “neck” can understandably make people nervous.
The procedure itself typically takes about 20 minutes. You lie on your back while the physician uses ultrasound guidance to identify the appropriate structures.
First, we numb the skin with a small amount of local anesthetic. The stellate ganglion block then uses a fine needle to deliver the anesthetic near the target area.
Most patients describe pressure rather than significant pain.
Some patients notice warmth or other temporary changes on the treated side of the face and neck. A temporary drooping eyelid, smaller pupil, or reduced sweating can also occur. These temporary changes are associated with a successful sympathetic block and typically resolve as the local anesthetic wears off.
Your physician will monitor you after the procedure and provide specific instructions before you leave.
SGB does not require general anesthesia. Whether a patient needs additional monitoring or medication depends on their individual medical circumstances.
For some patients, we consider SGB and ketamine as complementary treatment approaches. We do not necessarily administer them at the same time. Instead, the treatments may occur in sequence as part of an individualized plan.
Ketamine primarily affects brain signaling and neuroplasticity. SGB targets sympathetic nervous system signaling in the neck.
Patients with PTSD may experience both central psychological symptoms and significant physical symptoms of autonomic arousal. Addressing both areas may therefore make sense for certain patients.
The combination is still an area where more research is needed. Our approach is to evaluate the individual patient rather than assume that combining treatments will benefit everyone.
A thorough consultation can help determine whether SGB, ketamine, another treatment, or a combination of approaches makes sense for your situation.
Most patients are surprised by how manageable it is. The injection is guided by ultrasound imaging, which means we can see exactly what we’re doing — this isn’t a blind procedure. There’s some pressure and mild discomfort at the injection site, and a brief warming sensation in the face and neck that tells us we’ve landed in the right location. It takes about 20 minutes total. Most people sit up afterward, have some water, and are ready to drive themselves home within half an hour.
They’re working at different levels of the nervous system. Ketamine works centrally — resetting patterns in the brain by acting on the glutamate and NMDA receptor system, promoting rapid neuroplasticity. The SGB works peripherally — it targets the sympathetic nerve cluster that governs fight-or-flight signaling in the body. In PTSD, both the central fear-response circuits and the peripheral sympathetic system are dysregulated. The SGB quiets the peripheral activation directly and durably. For many patients, the combination addresses both dimensions in a way that neither does alone.
The strongest evidence is in patients with PTSD — particularly those with hyperarousal-dominant presentations. Think: hypervigilance, startle response, inability to feel calm even when safe, chronic sympathetic overdrive. There’s also growing interest in SGB for certain anxiety presentations, Long COVID autonomic symptoms, and treatment-resistant depression with autonomic dysregulation. It’s not the right tool for every patient, and we assess candidacy during your intake evaluation before recommending it. If you’re curious whether it applies to your situation, that’s exactly what the free consultation is for.
