Stellate ganglion block (SGB)

The SGB is an injection of anesthetic to a specific nerve bundle that reduces the “fight or flight” response, and helps improve symptoms of PTSD and Anxiety. Many of Dr. Smitherman’s patients have been able to overcome their crippling PTSD and Anxiety to regain their lives with this procedure.

Ultrasound Imaging Guidance for Accurate and Safe Injection Placement

Sterile Procedure Technique for Injection Safety

Duel Stellate and Superior Cervical Ganglion Technique

Hundreds of Successful Treatments Administered by Dr. Smitherman

Providing SGB for PTSD since 2020

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SGB Q&A

Insurance Coverage

Insurance does not cover SGB when performed for PTSD and/or Anxiety. Insurance may cover the office visit performed on the day of your SGB depending on your coverage, and Dr. Smitherman’s network status.

What is the success rate of the SGB?

70% of patients see a clinically significant and long lasting reduction in their PTSD symptoms that improve their day to day life in a meaningful way after a SGB.
20% of patients have a reduction in symptoms, but not significant.
10% of patients see no change in their symptoms at all.

How many SGB will I need?

An initial series of two injections on two consecutive days is recommended. Some patients may find that additional SGB are helpful for them if they are consistently in stressful situations, or feel that they can get further benefit from additional SGBs.

How fast does the SGB Work?

The SGB can provide relief from PTSD and anxiety symptoms instantly. Most people will notice a difference within 30 minutes. Some people need to be exposed to triggers to see that they are less responsive to those triggers than they were prior to the SGB.

How long does the result last?

A SGB can potentially last for as long as a person does not trigger a new PTSD event.

What are the risks of a SGB?

Dr. Smitherman has performed hundreds (at the time of this article update) of SGBs. Dr. Smitherman performs all SGB under ultrasound guidance to minimize risk. There are office procedures in place to handle any complications that arise. Most side effects are minor and self limiting. Dr. Smitherman will review all risks with each patient at the time of the visit

Will a SGB work with my medications and other treatments?

Dr. Smitherman will review your past medical history, and medications at your first office visit. A SGB will not interfere with your other therapies for PTSD or anxiety.

How does Dr. Smitherman perform the SGB?

Dr. Smitherman performs a SGB with ropivacaine anesthetic using ultrasound guidance at the level of the stellate ganglion and also at the superior cervical ganglion on one side of the body during the procedure. Then Dr. Smitherman repeats this on the other side on a separate day.

How long does the procedure take?

The entire injection procedure takes about 10 minutes. However, your appointment will be 120 minutes for the first visit, and 60-90 minutes on follow up visits in order to have time for discussion with Dr. Smitherman and integrate the injection in the office after the procedure.

First Office Visit: $200
First and Second SGB Series: $1,200 ($600 each)
Additional SGB: $300
Optional Calm and Relax IV: $250
Optional Procaine IV: $200
Optional Calm & Relax + Procaine IV: $300

PCL-5

Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past month

SGB PCL-5

1. Repeated, disturbing, and unwanted memories of the stressful experience?

2. Repeated, disturbing dreams of the stressful experience?

3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?

4. Feeling very upset when something reminded you of the stressful experience?

5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?

6. Avoiding memories, thoughts, or feelings related to the stressful experience?

7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?

8. Trouble remembering important parts of the stressful experience?

9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?

10. Blaming yourself or someone else for the stressful experience or what happened after it?

11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?

12. Loss of interest in activities that you used to enjoy?

13. Feeling distant or cut off from other people?

14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?

15. Irritable behavior, angry outbursts, or acting aggressively?

16. Taking too many risks or doing things that could cause you harm?

17. Being “superalert” or watchful or on guard?

18. Feeling jumpy or easily startled?

19. Having difficulty concentrating?

20. Trouble falling or staying asleep?

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Reference: Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement instrument]. Available from https://www.ptsd.va.gov/