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Stellate Ganglion Blocks

Calming anxiety and fear-based responses.

SGB for Anxiety

What are Stellate Ganglion Blocks? (SGBs)

Precise ultrasound-guided injections that target a collection of nerves in the neck and block impulses that trigger fear-based responses like PTSD (Post-Traumatic Stress conditions), insomnia and anxiety. Symptoms are often relieved in as little as 30 minutes and can last for years.

Experience Matters

NW Regen is the leading expert in SGB treatments in the Portland area, having performed close to 1,000 procedures since 2017. At each visit, we perform a complete “Cervical Sympathetic Blockade” as a standard of care, which means performing the block at the C4 and the C6 level. (Most clinics only treat the stellate ganglion at the C6 level.)

Inexperience in this procedure is a definite “NO“ for anyone looking to have this done. And, this procedure should NEVER be done blind, without ultrasound or fluoroscopy to guide the injection. In our opinion, ultrasound guided injections are the absolute gold standard. We use ultrasound to create a better visualization of the anatomy and to watch the needle during injections, increasing safety for our patients.


What Conditions Do They Treat?

  • Anxiety and PTSD (Post-Traumatic Stress conditions)
  • Work-related stress
  • Long COVID symptoms
  • ME/CFS
  • Dysautonomia
  • POTS
  • Parosmia
  • Anosmia
  • Sleep problems and nightmares
  • Postpartum depression
  • Complex regional pain syndrome or reflex sympathetic dystrophy
  • Compartment syndrome
  • Causalgia from nerve injuries
  • Autonomic dysfunction of the upper extremity
  • Herpes zoster infection (or “shingles”) affecting the head, neck, arm or upper chest
  • Phantom limb pain

Who else could benefit from SGB?

C-suite executives facing high stress levels may also benefit from SGB, improving strategic decision-making under pressure.

How does it work?

Stellate Ganglion Blocks have the ability to “reboot” the nervous system to a pre-trauma state, similar to rebooting a computer. When we inject an anesthetic (using an ultrasound for visual guidance), it blocks the nerve highway that carries information responsible for triggering fear and anxiety-based responses.

At NW Regen, we use a dual block, or cervical sympathetic blockade, as a more complete block to offer the best evidence-based care for the treatment of post-traumatic stress. That means we treat the upper cervical ganglion as well as the lower cervical ganglion during each session.

We often encourage patients to use this treatment as part of a full program with a behavioral health care specialist. Stellate Ganglion Blocks are effective at creating an immediate reduction in symptoms and a lasting calm that opens up a window of opportunity where other treatments, including behavioral therapies, can provide complete healing.

Why Choose NW Regen for SGB Treatments?

We provide a tailored, personal approach to helping patients, with direct doctor-to-patient consults, special expertise in SGB procedures, and recommendations for additional treatments for post-traumatic stress-related injuries. Because of our vast experience in this area, we’ve developed a support network of additional practitioners and other resources for a broader spectrum of care. This “team” approach, combined with the SGB procedure, can be extremely beneficial for post-traumatic-stress injuries.

Frequently-Asked Questions

How are Stellate Ganglion Blocks performed?

We cleanse the skin on your neck on either the right or left side depending on where we are performing the injection. Once sterile, we review the anatomy using ultrasound imaging including a Doppler scan of the blood supply to prepare for the injection. Once we isolate the upper cervical ganglion at C4 and the stellate ganglion at C6, we inject a small amount of anesthetic into the skin to numb the skin. We then slowly inject the anesthetic directly onto the stellate ganglion using a small needle followed with a similar injection at C4.

What will I experience right after the injection?

A successful SGB causes a Horner’s syndrome – a group of temporary symptoms “on the side of the injection” that show that the procedure was done correctly. Horner’s syndrome can include drooping of the upper eyelid, constriction of the pupil, appearance of a sunken eye, lack of facial sweating, redness of the white part of the eye, stuffy nose and increased skin temperature on the side of the injection. These symptoms will disappear shortly after the anesthesia wears off. Depending on the type of anesthesia used, it may be roughly 45 minutes to 4 hours before symptoms of a Horner’s response go away.

What will I experience later on?
Most patients experience a reduction in anxiety and have a general sense of calm within one hour of the procedure. Occasionally, very few patients experience a delayed response that happens after five days or so.
What other effects might I experience?

Often people experience other symptoms besides a Horner’s Syndrome following a block. These symptoms do NOT affect the outcome of a good block or mean that you’ve had a good block. They are simply the result of an incidental block to other nerves near the stellate ganglion and occur in as many as 50% to 60% of patients. These symptoms are temporary and can include trouble swallowing, a lump in the throat, or hoarseness, and they go away just like Horner’s syndrome.

How often do I need to repeat the injections?
Our standard treatment involves two injections within 10 to 14 days. The first injection resets the nervous system, and the second injection builds upon the first dose to improve results for most patients. For some conditions like reflex sympathetic dystrophy or complex regional pain syndrome, we perform this procedure weekly for up to six to eight weeks. Some patients also benefit from additional injections several months later.
How long has this procedure been around?
Longer than most people think! It was first used in the U.S. in 1925 to provide relief from chronic pain and then used again for depression in 1945 in The Cleveland Clinic. It was also used to help German prisoners of war recover from their experiences in Russian camps during World War II. However, experts believe it wasn’t used regularly until sometime after 1998.
Did I receive a good stellate block?

We ensure that no patient leaves our clinic without receiving a proper stellate block, which would mean at least three very noticeable signs of a classic Horner’s Syndrome on the side of the block: a droopy, puffy, or red eye; a smaller pupil; a stuffy nostril; or red/flushed face/neck/or arm. If these symptoms are not present, we will repeat as necessary.