Display options
Share it on

Chronic Stress (Thousand Oaks). 2021 Dec 08;5:24705470211055176. doi: 10.1177/24705470211055176. eCollection 2021.

Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape.

Chronic stress (Thousand Oaks, Calif.)

Jaimie Kerzner, Helen Liu, Ilya Demchenko, David Sussman, Duminda N Wijeysundera, Sidney H Kennedy, Karim S Ladha, Venkat Bhat

Affiliations

  1. Interventional Psychiatry Program, Psychiatric Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada.
  2. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
  3. Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  5. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
  6. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.

PMID: 34901677 PMCID: PMC8664306 DOI: 10.1177/24705470211055176

Abstract

Stellate ganglion block (SGB) is a procedure involving the injection of a local anesthetic surrounding the stellate ganglion to inhibit sympathetic outflow. The objective of this review was to summarize existing evidence on the use of SGB in adults with psychiatric disorders. A systematic search identified 17 published studies and 4 registered clinical trials. Eighty-eight percent of published studies, including 2 randomized controlled trials (RCTs), used SGB for posttraumatic stress disorder (PTSD), although its use for schizophrenia spectrum disorders was also explored. Administration of 1 to 2 SGBs using right-sided laterality with 0.5% ropivacaine was most common. Preliminary evidence from clinical trials and case studies supports the feasibility of SGB for treating psychiatric disorders involving dysregulation of the sympathetic nervous system, although effectiveness evidence from RCTs is mixed. One RCT concluded that improvement in PTSD symptoms was significant, while the other concluded that it was nonsignificant. Improvements were noted within 5 minutes of SGB and lasted 1 month or longer. Registered clinical trials are exploring the use of SGB in new psychiatric disorders, including major depressive disorder and borderline personality disorder. More studies with larger sample sizes and alternate protocols are needed to further explore therapeutic potential of SGB for psychiatric disorders.

© The Author(s) 2021.

Keywords: anesthesia; autonomic nerve block; posttraumatic stress disorder; psychiatric disorders; stellate ganglion; stellate ganglion block; sympathetic nervous system; sympatholytics; systematic review

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Kerzner, Liu, S

References

  1. Mil Med. 2021 Feb 13;: - PubMed
  2. Syst Rev. 2014 Jul 24;3:82 - PubMed
  3. Brain Cogn. 2007 Oct;65(1):69-76 - PubMed
  4. Can J Anaesth. 2002 Aug-Sep;49(7):758-9 - PubMed
  5. Pain Pract. 2017 Apr;17(4):546-553 - PubMed
  6. Psychol Assess. 2018 Mar;30(3):383-395 - PubMed
  7. Biol Psychiatry. 2003 Apr 15;53(8):649-59 - PubMed
  8. Mil Med. 2013 Apr;178(4):e473-6 - PubMed
  9. Aust N Z J Psychiatry. 2002 Feb;36(1):9-30 - PubMed
  10. Lancet Psychiatry. 2016 Feb;3(2):171-8 - PubMed
  11. Cureus. 2015 Sep 10;7(9):e320 - PubMed
  12. Reg Anesth. 1995 Jul-Aug;20(4):323-8 - PubMed
  13. Curr Neuropharmacol. 2016;14(7):665-73 - PubMed
  14. Curr Psychiatry Rep. 2019 Feb 7;21(2):10 - PubMed
  15. Indian J Anaesth. 2011 Mar;55(2):104-10 - PubMed
  16. Brain Behav. 2020 Nov;10(11):e01807 - PubMed
  17. Pain Pract. 2010 Jul-Aug;10(4):359-65 - PubMed
  18. Mil Med. 2013 Feb;178(2):e260-4 - PubMed
  19. Clin J Pain. 1990 Jun;6(2):153-7 - PubMed
  20. Mil Med. 2015 May;180(5):e601-4 - PubMed
  21. Am J Psychiatry. 2012 Jul;169(7):760 - PubMed
  22. Mil Med. 2014 Oct;179(10):1133-40 - PubMed
  23. Med Hypotheses. 2009 Jun;72(6):657-61 - PubMed
  24. JAMA Psychiatry. 2020 Feb 1;77(2):130-138 - PubMed
  25. J Trauma Stress. 2015 Dec;28(6):489-98 - PubMed
  26. Can J Anaesth. 2016 Jan;63(1):56-60 - PubMed
  27. J Psychiatr Res. 2015 Oct;69:57-66 - PubMed
  28. Cleve Clin Q. 1947 Jul;14(3):133-8 - PubMed
  29. Reg Anesth Pain Med. 2016 Jul-Aug;41(4):494-500 - PubMed
  30. Am J Psychiatry. 1955 Apr;111(10):751-5 - PubMed
  31. NPJ Schizophr. 2021 Apr 26;7(1):22 - PubMed
  32. Ann Clin Psychiatry. 2008 Oct-Dec;20(4):227-8 - PubMed
  33. Front Psychol. 2017 Nov 30;8:2054 - PubMed
  34. Reg Anesth Pain Med. 2007 May-Jun;32(3):203-8 - PubMed
  35. Mil Med. 2016 Sep;181(9):1135-41 - PubMed
  36. Mil Med. 2012 Feb;177(2):125-7 - PubMed
  37. J Investig Med. 2021 Jun;69(5):989-993 - PubMed

Publication Types