Stellate Ganglion Block (SGB)

What Is the Stellate Ganglion Block?

The stellate ganglion is a collection of sympathetic nerve cell bodies located in the lower neck, just anterior to the seventh cervical vertebra (C7). It is part of the sympathetic nervous system — the “fight-or-flight” division of the autonomic nervous system — and serves as a major relay center for sympathetic signals throughout the head, neck, upper extremities, and thorax. In individuals with PTSD, chronic anxiety, and certain pain conditions, the sympathetic nervous system becomes chronically overactivated — stuck in a persistent state of threat-response that drives hypervigilance, anxiety, intrusive memories, nightmares, sleep disturbances, and the physical symptoms of chronic stress. The Stellate Ganglion Block works by injecting a small, precise amount of local anesthetic adjacent to the stellate ganglion under real-time ultrasound imaging guidance. This temporarily interrupts the overactive sympathetic signaling flowing through the ganglion — essentially “resetting” an overloaded nervous system to a more balanced, regulated baseline. The effect is not sedation or chemical suppression — it is a genuine neurological reset that allows the autonomic nervous system to recalibrate toward a less hyperactivated state. Clinical studies, particularly in military veterans with combat-related PTSD, have shown that SGB can produce rapid and significant reductions in PTSD symptom severity — including hyperarousal, re-experiencing, avoidance, and nightmares — with effects often beginning within hours to days of the procedure and lasting weeks to months.

Conditions Treated with SGB at Hawaii Wellness Clinic

At Hawaii Wellness Clinic, the Stellate Ganglion Block is used as a targeted intervention for the following conditions.

PTSD and Trauma-Related Hyperarousal

SGB is one of the most exciting developments in PTSD treatment in decades — providing rapid relief from the hyperarousal, hypervigilance, nightmares, and anxiety that characterize this condition. It is particularly effective for patients with treatment-resistant PTSD who have not achieved adequate relief through psychotherapy and medication alone. At Hawaii Wellness Clinic, SGB is a core component of our comprehensive PTSD treatment program, combined with ketamine therapy and neurofeedback for patients seeking the most comprehensive possible relief.

Anxiety Disorders

For patients with severe anxiety — particularly those with significant physical hyperarousal symptoms such as racing heart, chest tightness, and difficulty breathing — SGB provides a targeted intervention that addresses the sympathetic overdrive driving these symptoms at their neurological source. It is a valuable complement to our broader anxiety treatment program.

Menopausal Hot Flashes

SGB has demonstrated strong clinical evidence as a treatment for moderate to severe menopausal hot flashes — providing significant reduction in hot flash frequency and severity in women who cannot or prefer not to use hormone therapy. The sympathetic nervous system plays a central role in thermoregulatory dysfunction underlying hot flashes, and SGB’s sympatholytic effect directly addresses this mechanism.

Chronic Pain Conditions

SGB is effective for a range of pain conditions in which the sympathetic nervous system plays a maintaining or amplifying role — including Complex Regional Pain Syndrome (CRPS), sympathetically maintained pain syndromes, post-herpetic neuralgia, certain chronic pain conditions of the neck and upper extremity, Raynaud’s phenomenon, and vascular insufficiency affecting the upper limbs. By interrupting aberrant sympathetic signaling, SGB can reset pain circuits and significantly reduce pain intensity in these conditions.

Headache and Migraine

For patients with frequent or chronic migraines and cluster headaches that involve significant autonomic dysregulation, SGB can reduce headache frequency and severity by addressing the sympathetic component of the trigeminovascular inflammatory cascade that underlies these conditions.

The SGB Procedure at Hawaii Wellness Clinic

The Stellate Ganglion Block at Hawaii Wellness Clinic is a brief, minimally invasive outpatient procedure performed entirely within our clinic. The total procedure time is typically 15 to 30 minutes from preparation to recovery. You will lie comfortably on your back on the procedure table. The skin of the neck is cleaned with antiseptic solution. Your board-certified anesthesiologist will use a high-resolution ultrasound transducer to identify the stellate ganglion and surrounding structures in real time — including the carotid artery, jugular vein, trachea, and cervical vertebrae — ensuring precise needle placement and avoiding adjacent structures. A fine needle is then advanced under continuous ultrasound visualization to the target site, and a small volume of local anesthetic (typically bupivacaine) is injected precisely adjacent to the ganglion. You will typically feel mild pressure during needle advancement. Following the injection, you will be monitored in our recovery area for 30 to 45 minutes. The onset of block effect is usually confirmed by the development of Horner’s syndrome on the treated side — a harmless and temporary constellation of findings (mild eyelid drooping, pupillary constriction, and facial warmth) that indicates the block has taken effect. This fully resolves as the anesthetic wears off, typically within a few hours. Many patients notice a significant reduction in anxiety, hyperarousal, and tension beginning within hours to a few days of the procedure.

SGB Treatment Protocols

At Hawaii Wellness Clinic, SGB treatment protocols are individualized based on your condition, symptom severity, and treatment response. A single SGB often provides weeks to months of meaningful symptom relief. For patients requiring more sustained benefit, a series of two to three blocks spaced one to two weeks apart is frequently recommended. Follow-up visits allow our team to track your progress, integrate complementary therapies, and plan any maintenance treatments needed to sustain your relief over the long term.

Safety and Expertise

The Stellate Ganglion Block has an excellent safety profile when performed by trained, experienced clinicians using real-time ultrasound guidance. All SGBs at Hawaii Wellness Clinic are performed exclusively by board-certified anesthesiologists with advanced training in ultrasound-guided regional anesthesia — the same specialists who manage complex nerve block procedures in major medical centers. Potential complications — which are rare with ultrasound guidance — include temporary hoarseness (from proximity to the recurrent laryngeal nerve), temporary Horner’s syndrome (expected and resolves fully), minor bruising or soreness at the injection site, and in very rare cases, inadvertent vascular puncture, all of which are minimized by our meticulous technique.

Why Choose Hawaii Wellness Clinic for Stellate Ganglion Block?

At Hawaii Wellness Clinic in , our SGB program is delivered by board-certified anesthesiologists with extensive experience in this specialized procedure — using the highest-precision ultrasound imaging available in our dedicated procedure rooms. We approach every SGB with the trauma-informed care and deep respect that our patients — particularly veterans, first responders, and trauma survivors — deserve. Our SGB procedures integrate seamlessly with our broader PTSD, anxiety, and chronic pain programs, and are available to veterans and first responders at a significantly discounted rate. Our clinics on O’ahu, Hawai’i Island, and Maui are open and ready to help. Call us at (808) 201-2343 - Honolulu Office , (808) 201-2343 - Kailua Kona Office or (808) 201-2343 - Hilo Office to schedule your SGB consultation today.

Frequently Asked Questions About Stellate Ganglion Block in Hawaii