FAQ

PTSD is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, combat, or rape or who have been threatened with death, sexual violence or serious injury. Some propose using the term Post-traumatic stress injury (PTSI) to de-stigmatize the term “disorder” and to indicate the biologic nature of the traumatic injury sustained which can be healed with proper treatment, such as stellate ganglion block.

Many people who are exposed to a traumatic event experience symptoms such as:

• Being irritable or easily startled, having angry outbursts or problems concentrating or sleeping

• Distressing dreams or repeated, involuntary memories

• Avoiding activities and situations that may trigger distressing memories

• Feeling detached or estranged from others or difficulty experiencing positive emotions

For a person to be diagnosed with PTSD, these symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functioning. Symptoms may appear years after the trauma and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime.

The overall risks of having a significant adverse event are very small (much less than 1 in 1000) when done by a skilled provider with ultrasound guidance. There is a very small risk of a seizure from inadvertently injecting the local anesthetic into a blood vessel. There is an extremely small risk of forming a dangerous hematoma (collection of blood from a bleeding vessel). This risk is very small in people not taking blood thinning medications. SGB should not be done in people currently on blood thinning medications. About 20 percent of the time after a block, some patients get a hoarse voice or feel like there is something in the back of their throat. This occurs when the anesthetic spreads to another nerve near the larynx. This is not a mistake, it just happens sometimes. The hoarse voice or feeling in your throat, if it occurs, will wear off in 3-6 hours.

The doctors routinely performs the SGB at the 6th cervical vertebral level (C6). After the June 2020 publication by Dr. Mulvaney, which shows that two level blocks may be more beneficial, clinical practice changed so patients will also be offered an additional injection at higher cervical levels such as C4 or C3. Although there are over 20 peer-reviewed medical publications showing efficacy and safety when the SGB is done at the C6 level, Dr. Mulvaney’s June 2020 publication was the first study showing that two level blocks may be more beneficial. There are well-referenced anatomical differences in how a person’s sympathetic chain courses through their neck which may explain the additional benefits of a two level block in some patients. There is no additional fee if additional levels are performed.

Ultrasound allows the needle to be safely guided around the nerves and blood vessels in the neck as it is placed next to the stellate ganglion. Under x-ray (fluoroscopic) guidance, only bones are visible, so nerves are not visible at all and their position can only be approximated. Using ultrasound guidance to safely perform an SGB takes special training and considerable skill, which many pain medicine trained physicians do not have. Although during his fellowship in anesthesia/pain medicine at Walter Reed National Military Medical Center, Dr Mulvaney learned to do SGBs with fluoroscopic-guidance, he rejected this method as being more painful, less efficacious and unnecessarily risky as it exposes patients to contrast dye and ionizing radiation from the x-ray. Doesn’t it just make sense that you should be able to actually see your target as well as avoiding major blood vessels and nerves?

About one third of patients are successfully treated with a single SGB and do not need another SGB. Some people may be exposed to conditions that “re-trigger” their PTSD symptoms and need another treatment in the future. It can be safely repeated if it was helpful the first time.Completing follow up PCL-5 surveys at one week and one month after your SGB is performed is very important so we can document whether this was a good therapy for you.

Over a 10-year period, Dr. Mulvaney has completed over 2000 ultrasound-guided SGBs and is the most experienced physician in the world at this technique. He has been an invited speaker on nationally broadcast television, including the CBS show 60 Minutes.

He is an academic physician and has published 8 studies and papers on this topic and routinely is an invited lecturer on this topic in major national and international stages. He has taught hundreds of physicians neck sonographic anatomy and SGB technique. As a fellowship-trained and board-certified interventional pain physician, he is also proficient in fluoroscopically (x-ray) guided SGBs, but he strongly feels that the fluoroscope method is more painful, less accurate and unnecessarily exposes patients to ionizing radiation.

No. Sedation actually significantly increases the risk of this procedure. I have performed over 2000 SGBs and not used sedation on a patient. This procedure is NOT painful. Most patients describe it as a 1/10 for pain. The environment in my clinic is calm, and I will talk you through everything. Even people who don’t like needles will do fine.

Everyone is screened prior to being scheduled. No additional appointment is needed for screening.

The accepted medical practice is that you cannot drive for 8 hours after this procedure. Please plan to have a driver with you or use a driving service like Uber.

The Stellate Ganglion is part of the cervical sympathetic chain, a key part of the sympathetic nervous system, which is the “fight or flight” nervous system. In PTSD and some other anxiety conditions, the “fight or flight” nervous system gets stuck in the “ON” position. By precisely placing long-acting local anesthetic (ropivacaine) around the stellate ganglion, the unproductive and chronic “fight or flight” response is turned off for several hours. Dr Mulvaney and other researchers believe this allows the brain and the body to “reset” back to a non-anxiety state. The brain has a quality called “neuroplasticity”, which means it can actually have durable change in response to treatments like an SGB. What we do know and can measure is this “resetting” results in long-term relief of anxiety symptoms.