What is a Stellate Ganglion Block?

A stellate ganglion block (SGB) is an injection performed at the base of the neck, where a group of nerves called the stellate ganglion is located. These nerves are part of the sympathetic nervous system, which controls the body’s “fight or flight” responses — such as heart rate, blood flow, sweating, and stress reactions.

When this system becomes overactive, it can contribute to chronic pain in the face and arms, complex regional pain syndrome (CRPS), migraines, anxiety, depression, PTSD, and even lingering symptoms after viral illnesses such as long COVID. By calming these nerve signals, stellate ganglion block may help restore balance.

Why Sympathetic Nerves Matter

The sympathetic nervous system is designed to protect us in emergencies. However, in some people it remains “switched on” even when it’s not needed. This constant overdrive can cause:

• Chronic face and arm pain from nerve irritation or abnormal blood flow
• CRPS (complex regional pain syndrome) with burning pain, swelling, and skin changes
• PTSD, anxiety, and depression linked to heightened stress responses
• Long COVID symptoms such as fatigue, brain fog, and sleep disturbance

By temporarily blocking the stellate ganglion, the procedure can help “reset” this overactive system and allow the brain and body to recover.

Indications & Uses

Stellate ganglion block is used in diagnosing or treating conditions related to nerve pain and circulation. Common applications include:

• Complex regional pain syndrome (CRPS)
• Phantom limb pain
• Postherpetic neuralgia (pain after shingles)
• Orofacial pain (pain in the face or mouth)
• Chronic post-surgical pain
• Migraines and atypical chest pain

In addition to pain and circulation problems, SGB has shown promise for mental health conditions such as PTSD, anxiety, and depression by reducing overactivity in the stress pathways.

The Procedure: What to Expect

1. Preparation & sedation (optional): You may be given a mild sedative via IV if needed. The procedure is short, well tolerated, and in over 95% of cases local anesthesia alone is sufficient.
2. Positioning & sterilization: You will lie on your back while the neck area is cleaned and disinfected.
3. Ultrasound guidance: Using real-time ultrasound, the physician locates the correct spot in the neck.
4. Injection: A specialized nerve block needle delivers local anesthetic near the stellate ganglion.
5. Monitoring & recovery: After injection, you will rest for 30–60 minutes while the team monitors for side effects. You’ll need someone to drive you home.

The entire procedure usually takes less than 30 minutes.

Treatment Course

• Relief may be felt shortly after the first injection.
• Most patients require 3–4 treatments to achieve longer-lasting improvement.
• Benefits can include reduced pain, better mood, improved sleep, and greater overall function — without dependence on daily medications or antidepressants.

Possible Side Effects

Most side effects are mild and temporary, such as:

• Drooping eyelid
• Red or watery eye
• Hoarseness or mild swallowing difficulty
• Warmth or tingling in the arm

These usually resolve within a few hours. Serious complications are rare when the procedure is performed with ultrasound guidance by experienced specialists. However, because the stellate ganglion lies close to major blood vessels, accidental injection into a vessel remains the most significant concern.

Is Stellate Ganglion Block Safe?

Safety depends on technique and expertise, here are some high safety standards to minimize the risks.

• Real-time ultrasound guidance: continuous visualization of the needle and surrounding structures.
• Specialized blunt-tip nerve block needle: designed for ultrasound use, reduces the risk of vascular puncture, and is clearly visible on imaging.
• Precise small dose local anesthetic delivery to the stellate ganglion.
• Experienced pain specialists trained in advanced nerve block procedures.

This combination makes the procedure safer compared to older methods that relied on X-rays or blind needle placement. While the use of advanced equipment and specialized needles may increase cost, it maximizes safety and accuracy.

Who is Not Suitable for a Stellate Ganglion Block?

While stellate ganglion block is generally safe, it may not be appropriate for everyone. The procedure is usually avoided in people who have:

• Uncontrolled bleeding disorders
• Active infection at the injection site or systemic infection
• Severe lung disease
• Allergy to local anesthetics
• Severe heart conditions
• Pregnancy (due to limited safety data)

Conclusion

A stellate ganglion block is a safe and effective option for people living with chronic face or arm pain, CRPS, migraine, anxiety, depression, PTSD, or long COVID symptoms. By calming the sympathetic nervous system, it offers a chance to relieve pain, improve mood, and restore quality of life — often without the need for daily medication or antidepressants.

With modern techniques such as real-time ultrasound guidance and specialized blunt-tip nerve block needles, the procedure can be performed with maximum precision and safety. For many patients, a short series of treatments provides meaningful and lasting relief.

If you are considering a stellate ganglion block in Bangkok, consult with an experienced pain specialist to see whether this treatment may be right for you.