Mental Health
Stellate ganglion block for PTSD, Long COVID, and treatment-resistant depression.
Written by the clinical team at Kentuckiana Integrative Medicine. Reviewed by Dr. Rafael F. Cruz, MD.
What the stellate ganglion block is
The stellate ganglion is a bundle of sympathetic nervous system neurons at the base of the neck. When it fires in an overactive pattern, the body sits in a fight-or-flight state the patient cannot talk themselves out of. A stellate ganglion block, usually shortened to SGB, is a precise injection into the tissue around that ganglion. SGB is an off-label application for PTSD, Long COVID, and treatment-resistant depression; off-label use is a common and lawful practice of medicine directed by a licensed physician. When the block works, sympathetic tone may drop, heart rate may settle, and some patients describe a sense that the nervous system stops treating ordinary life as a threat. Individual results vary.
The standard SGB is a lidocaine injection. Lidocaine is a local anesthetic, so the block it produces is temporary, and the technique carries a known short list of risks. Patients can experience a drooping eyelid, a hoarse voice, a pneumothorax, and in rare cases a seizure if the injection lands in the wrong tissue plane. Relief, when the standard block works, typically lasts weeks to months before repeat is considered.
The KIM enhancement: Photo-Energized PRP instead of lidocaine
At Kentuckiana Integrative Medicine, Dr. Cruz performs a proprietary version of the stellate ganglion block using high-dose, photo-biomodulated PRP with procaine and B vitamins, instead of lidocaine. PRP is an autologous biologic regulated under 21 CFR 1271; this information is intended for educational purposes and FDA has not evaluated these statements. The change is intended to avoid the cluster of risks associated with lidocaine in this tissue plane, and PRP carries growth factors and signaling proteins that may support nerve healing. Some patients in our clinic report longer relief than the standard SGB (internal clinical observations; individual results vary).
We are not aware of another clinic in the region offering the SGB this way. The technique requires ultrasound guidance, a physician trained in the anatomy, and access to the photo-energized PRP preparation, which is the same advanced PRP we use in our regenerative and neurological programs.
The patients who benefit most
In our clinic, we use the SGB for six main patient types. First, PTSD patients for whom talk therapy and medication have reached a ceiling. Second, Long COVID patients whose autonomic nervous system has not returned to baseline after the acute infection resolved. Third, patients with Complex Regional Pain Syndrome, usually paired with our ketamine and neridronate-equivalent protocols. Fourth, treatment-resistant depression patients who do not respond fully to the 5R ketamine protocol alone. Fifth, patients with severe hot flashes unresponsive to hormonal management. Sixth, patients with Raynaud's phenomenon and related sympathetic-driven vascular symptoms.
The SGB is not a cure for any of these conditions. It is a targeted intervention that, in appropriately selected patients, may open a window for other therapies to work better. Some patients on our ketamine program who add the SGB report that ketamine responses last longer (internal clinical observations; individual results vary). Long COVID patients pair the SGB with IV nutrition and targeted medication. PTSD patients keep their therapist and add the SGB to give that work traction.
What a visit looks like
An SGB visit starts with a standard mental-health or medical consultation to confirm the patient is a candidate. The injection itself is performed under ultrasound guidance in our procedure room, with the patient awake and lying flat. Many patients report a brief pressure sensation and a warm feeling in the face or hand on the treated side within minutes; individual experiences vary. We observe you for a period, document the baseline response, and outline the follow-up plan. Some patients schedule a series of three SGBs spaced to stack the benefit.
Our SGB is priced at $3,000 per injection, or $7,500 for a prepaid series of three (save $1,500). Patients committing to the series are credited the original $300 consultation fee.
How to know if this is the right next step
The patients who benefit most from the SGB almost always share a pattern. They have tried the standard of care. They have a provider who is already doing good work with them. They are stuck at a ceiling that feels physiological rather than psychological, their body is keeping the score in a way that talk and medication cannot fully reach. If that description sounds like your situation, the consultation will tell us, and you, whether the SGB belongs in your plan.
See the ketamine and mental health service page for the related 5R protocol, or request a consultation.
