The Use of Stellate Ganglion Block in the Treatment of Panic/Anxiety Symptoms with Combat‐Related Post‐Traumatic Stress Disorder; Preliminary Results of Long‐Term Follow‐Up: A Case Series

Sean W. Mulvaney · Brian C. McLean · Jason de Leeuw

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Posttraumatic Stress Disorder Research Pain Management and Treatment Electroconvulsive Therapy Studies

Abstract

OBJECTIVE: Report the successful use of stellate ganglion blocks (SGBs) in two patients experiencing symptoms of post-traumatic stress disorder (PTSD). BACKGROUND: Successful treatment of PTSD with SGB has been reported previously. A similar protocol was employed at Walter Reed Army Medical Center to treat two soldiers with chronic, combat-related PTSD. METHODS: Both patients received a SGB on the right side at C6 level. The patients' PTSD symptoms were evaluated using the Post-traumatic Stress Disorder Checklist (PCL). The PCL was administered the day prior to treatment, to establish a baseline, and the day after treatment. The PCL was also utilized during follow-up visits to quantify the patient's symptomotology. The SGB was administered by an anesthesiologist and the psychometric tests administered by a psychologist. RESULTS: Both patients experienced immediate, significant and durable relief as measured by the PCL (score minimum 17, maximum 85). In both instances, the pre-treatment score suggested a PTSD diagnosis whereas the post-treatment scores did not. One patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients discontinued all antidepressant and antipsychotic medications while maintaining their improved PCL score. CONCLUSION: Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications. blacksquare, square, filled.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 1995Posttraumatic Stress Disorder in the National Comorbidity Survey 2004Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care 1996Psychometric properties of the PTSD checklist (PCL)2008Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with soldiers returning from combat.2003Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study 2001The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD 1987Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder

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2016Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder

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