The stellate ganglion block (SGB) is a minimally invasive medical procedure. It involves the injection of a local anesthetic into the stellate ganglion — a cluster of sympathetic nerve cells in the neck. The purpose of the SGB is to calm the overactivation of the sympathetic nervous system (‘fight-or-flight’ response), which underlies many PTSD symptoms.
70–80% of patients experience significant reductions in hyperarousal, hypervigilance, nightmares, and anxiety after the procedure, according to research [1]. For people who have not responded to medication or therapy alone, SGB is a compelling option.
What Is the Stellate Ganglion?
The stellate ganglion is a collection of sympathetic nerve fibers located at the base of the neck, near the C6–C7 vertebrae. It acts as a relay station for the body’s stress response. Repeated trauma in people with PTSD can permanently sensitize this system, keeping it in a state of chronic activation even when no threat is present [2].
Researchers believe trauma causes nerve growth factor (NGF) to accumulate in the stellate ganglion, promoting abnormal nerve sprouting that locks the sympathetic system into overdrive. That signaling pathway is temporarily interrupted with the local anesthetic, which blocks this ganglion, allowing the nervous system to reset [3].
How the Procedure Works
SGB takes 15–30 minutes and is performed by a trained pain specialist or anesthesiologist. Ultrasound guidance is used to improve accuracy and reduce risk [1].
- The patient lies on their back and slightly extends their neck.
- The physician uses ultrasound to locate the stellate ganglion.
- A local anesthetic is delivered by a thin needle to the ganglion site.
- A temporary warm, flushed feeling in the face and neck confirms the block is working.
- The patient rests briefly, then is discharged the same day.
Current evidence supports bilateral injections (both sides of the neck) delivered at two cervical levels for stronger and longer-lasting results [4].
Candidate Profile for SGB Treatment for PTSD
SGB is targeted to help adults with PTSD who:
- Experience marked symptoms of hyperarousal.
- Have not responded adequately to first-line treatments for trauma such as Eye Movement Desensitization and Reprocessing (EMDR) or SSRI anti-depressants.
- Who seek a rapid reduction in overactivation of the sympathetic nervous system to make other therapies more accessible.
Rather than a standalone intervention, SGB is typically used as a complementary procedure to comprehensive trauma treatment.
Duration of Relief from SGB
Studies using bilateral two-level injections show sustained symptom relief for at least three months in most patients [4]. Some individuals report benefits lasting six months or longer. Repeat injections can be performed if symptoms return.
What the Research Shows
Evidence for SGB in PTSD has grown substantially since the first military trials in the early 2010s. Significant reduction in PTSD symptoms following SGB was shown in studies funded by the U.S. DOD.
A landmark 2019 study showed a clinically meaningful reduction in PTSD symptom severity within weeks of a single injection. In individuals with PTSD where hyperarousal is predominant, results appeared fastest and most robust [5].
Other key findings include:
- SGB produced a significantly greater reduction in PTSD symptoms than placebo procedures in another controlled trial [6].
- Large-scale military studies reported 70–80% of active-duty personnel and veterans experienced meaningful relief in hyperarousal, avoidance, and intrusion symptoms [1].
- Benefits typically begin within 24–72 hours after injection and have been documented to persist for three months or longer with the bilateral two-level technique [4].
- Civilian samples show comparable response rates to military populations [1].
SGB Compared to Other PTSD Treatments
| Treatment | How It Works | Key Consideration |
| SGB | Resets sympathetic nervous system | Single procedure; works for people who don’t respond to medication |
| SSRIs/SNRIs | Modulates serotonin/norepinephrine | Daily medication; 40–60% response rate |
| Cognitive Processing Therapy | Reframes trauma-related thoughts | 12 sessions; high dropout in severe cases |
| Prolonged Exposure Therapy | Gradual trauma memory processing | Strong evidence; can increase short-term distress |
Is Stellate Ganglion Block Safe?
SGB has been used in medical practice for decades as a pain management procedure and is considered safe when performed by a trained physician under imaging guidance (typically ultrasound or fluoroscopy). At Corner Canyon, a thorough medical evaluation is conducted prior to SGB treatment.
Most side effects are temporary and resolve within a few hours [2].
- Common and temporary: drooping eyelid (Horner syndrome), hoarse voice, nasal congestion, warm flush, and mild neck soreness lasting a few hours.
- Rare but serious: several side effects showed in fewer than 1% of procedure.
- Contraindications: several are listed, which will disqualify the patient from the procedure.
Does Insurance Cover SGB for PTSD?
Insurance coverage for SGB as a PTSD treatment is evolving as clinical evidence accumulates. Coverage varies significantly by insurer and plan. Corner Canyon’s clinical and admissions team works with clients to explore coverage options and can provide documentation of medical necessity to support insurance authorization where applicable
SGB and Trauma-Informed Care
Researchers now emphasize that SGB works best as part of a broader treatment plan. Reducing hyperarousal through the block can lower the physiological barrier that prevents patients from engaging with psychotherapy.
Clinicians report that patients who receive SGB are often better able to participate in Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing therapy (EMDR), and other evidence-based approaches because their nervous systems are calmer [7].
SGB for co-occurring conditions such as sleep disturbances, traumatic brain injury, generalized anxiety disorder, and treatment-resistant depression is being explored in emerging research, signaling a potential expansion of its applications in mental health care [8].
SGB Compared With Ketamine Treatment for PTSD
Both SGB and ketamine-assisted psychotherapy offer rapid-onset PTSD symptom relief but through different mechanisms.
SGB targets overactivation of the sympathetic nervous system through the cervical ganglion. Ketamine works through the glutamate system in the brain to rapidly reduce depression and trauma symptoms and requires integration therapy.
The two can be complementary and are both available at Corner Canyon.
Trauma-Informed Treatment in Salt Lake County
Treatment for mental health conditions and trauma is available in Utah. Are you or a loved one looking for a compassionate space to heal from OCD, anxiety, trauma, PTSD, CPTSD, other mental health conditions, or addictions?
Our licensed trauma-informed therapists and counselors at Corner Canyon Health Centers can provide knowledgeable, empathic help using a range of therapeutic and holistic techniques. We also offer ketamine-assisted psychotherapy for treatment-resistant depression.
Reach out to our admissions team at Corner Canyon now. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.