Stellate ganglion block for posttraumatic stress disorder in Canadian Armed Forces Veterans and Royal Canadian Mounted Police: A case series

Introduction: Current treatments for posttraumatic stress disorder (PTSD) have shortcomings and less success in military Veterans. A significant challenge for recovery from PTSD is overcoming persistent and often intractable sympathetic hyper-arousal. This treatment gap has prompted the use of stellate ganglion block (SGB), an interventional procedure originally targeted toward upper regional pain, for treating symptoms of PTSD. Several studies have shown a rapid and sustained reduction of hyper-arousal and anxiety after SGB. This study aimed to replicate existing findings by evaluating the effectiveness of SGB in a sample of Canadian Armed Forces (CAF) Veterans and Royal Canadian Mounted Police (RCMP) with PTSD. Methods: Right-sided SGB was performed with an ultrasound-guided injection of bupivacaine around the stellate ganglion in the neck of 26 participants. Self-report data were collected at one week pre-SGB and one and eight weeks post-SGB. Measures included the PTSD Checklist for DSM-5, Quick Inventory of Depressive Symptomatology, and the Outcome Questionnaire. Results: Participants reported lower PTSD and depression symptoms and overall distress at eight weeks post-SGB. Treatment responders evidenced greater reductions in intrusions and hyper-arousal at eight weeks post-SGB compared to non-responders. Treatment responders also reported global reductions in severity of depression and distress by eight weeks post-SGB compared to non-responders. Discussion: Results support clinical utility of SGB in reducing symptoms of PTSD and depression in CAF Veterans and RCMP. No significant adverse events were linked with the procedure. Further studies may examine optimal parameters for SGB’s use as an adjunctive treatment for PTSD and expand its use to other populations.