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Stellate ganglion block
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{{NeedsImage}} A '''stellate ganglion block''' or '''stellate ganglion blockade''' or '''SGB''' or '''cervicothoracic ganglion block''' is a [[nerve block]] injection in the lower neck/upper back area, either on the left or the right side.<ref name="cs">{{Cite web|url=https://www.cedars-sinai.org/programs/pain-center/conditions-treatments/stellate-ganglion-blocks.html | title = Stellate Ganglion Blocks|website=Cedars-Sinai|language=en-US|access-date=2021-12-25}}</ref> ==Theory== The stellate ganglion, also known as the cervicothoracic ganglion, is present in 80% of the population, and forms by a natural fusion between the inferior cervical ganglion and first thoracic ganglion.<ref name="NBK539807">{{Cite book | title = Neuroanatomy, Stellate Ganglion | date = 2021 | url=http://www.ncbi.nlm.nih.gov/books/NBK539807/ | last = Mehrotra | first = Mayank | last2 = Reddy | first2 = Vamsi | last3 = Singh | first3 = Paramvir|location=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30969629}}</ref> A nerve block is preformed on this ganglion by injecting the adjacent interstitial tissue with a local anesthetic and/or steroid, typically under the guidance of ultrasound or fluoroscopy. Stellate ganglion blocks were proposed as a treatment for [[dysautonomia]] symptoms in [[Long COVID]] by Liu and Duricka (2021) based on their treatment of just two patients.<ref name="Liu2022" /> Liu and Duricka proposed that a stellate ganglion block on both sides may cause a "reset" of the [[sympathetic nervous system]] (SNS), which they propose could allow it to return to [[homeostasis]], resolving or improving dysautonomia symptoms. Changes to the sympathetic nervous system affect the [[parasympathetic nervous system]] (PNS), which is the other key part of the autonomic nervous system. Dysautonomia is a range of conditions involving the failure of parts of the SNS and PNS, and sometimes over or underactivation.<ref name="ninds">{{Cite web|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Dysautonomia-Information-Page | title = Dysautonomia Information Page | last = | first = | authorlink = | date = |website=[[National Institute of Neurological Disorders and Stroke]]|archive-url=|archive-date=|url-status=|access-date=2021-12-25}}</ref> ==Evidence== Liu and Duricka published a case study of two [[Long COVID]] patients, both women in their 40s, who had received stellate ganglion blocks on both left and right sides at their clinic. Patient self-reports were the only results, there were no medical readings or measures reported: *significant improvement in [[cognitive dysfunction]], especially long-term memory recall *improvements in [[fatigue]] *sense of smell and taste returning to normal<ref name="Liu2022"/> ==Clinicians== Luke Liu and Deborah Duricka at [[Neuroversion, Inc.]], Anchorage, Alaska. ==Risks and safety== * Horner's syndrome results from a successful stellate ganglion block, which is expected to resolve after the block wears off.<ref name="Liu2022" /> * Liu and Duricka's study is a pre-print and not yet peer reviewed, peer review may highlight significant issues or prevent publication. * No medium or long term follow-up information is available for the Liu and Duricka study. It is not known how long the beneficial effects may last, and later complications or issues may develop. * Potential conflict of interest by Liu and Duricka, who performed the treatments at the pain clinic Liu owns and where Duricka is employed, leading to possible financial gain from future patients * No case series or controlled trials in men, different ethnic groups, or with younger or older people, people with ME/CFS, or people with other medical conditions * Extremely small case series, which has not been duplicated by other clinicians. * No indication of whether the same treatment has resulted in different results in different patients * Nerve block risks - these are reasonably well established ==Costs and availability== ==Notable studies == *2022, Stellate ganglion block reduces symptoms of Long COVID: A case series<ref name="Liu2022">{{Cite journal | title = Stellate ganglion block reduces symptoms of Long COVID: A case series | date = 2022-01-15|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/|journal=Journal of Neuroimmunology|volume=362|pages=577784 | last = Liu | first = Luke D. | last2 = Duricka | first2 = Deborah L.|doi=10.1016/j.jneuroim.2021.577784|pmc=8653406|pmid=34922127|issn=0165-5728}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406 (Full text)] ==See also== *[[Nerve block]] *[[Dysautonomia]] *[[Sympathetic nervous system]] (SNS) *[[Long COVID]] *[[Dorsal root ganglion]] *[[Neuroversion, Inc.]] ==Learn more== *[https://www.cedars-sinai.org/programs/pain-center/conditions-treatments/stellate-ganglion-blocks.html Stellate Ganglion Block] - Cedars Sinai Medical Center *[https://www.ncbi.nlm.nih.gov/books/NBK539807/ Neuroanatomy, Stellate Ganglion] - StatPearls book ==References== {{reflist}} [[Category:Potential treatments]] [[Category:Analgesics]] [[Category:Nerve-based treatments]]
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