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Stellate ganglion block particularly effective at treating ‘fight-or-flight’ PTSD symptoms, analysis finds

Secondary analysis of RTI's landmark randomized controlled trial highlights therapeutic benefits of stellate ganglion block

RESEARCH TRIANGLE PARK, N.C. — A new analysis from nonprofit research institute RTI International has found that stellate ganglion block (SGB), a procedure that involves injecting a local anesthetic into a cluster of nerve cells in the neck, is particularly effective at treating symptoms of posttraumatic stress disorder (PTSD) related to arousal and reactivity.

The analysis examined data from RTI’s landmark randomized controlled trial on SGB and focused on the four PTSD symptom categories, or “clusters,” defined by the Diagnostic and Statistical Manual of Mental Disorders as re-experiencing, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity.

Researchers found that participants who were administered SGB experienced the most notable symptom reduction in the arousal and reactivity cluster, which is associated with hypervigilance, concentration difficulties, and sleep disturbances.

“Prior to this analysis, there was little evidence that certain PTSD symptoms were more responsive to SGB treatment than others, but it stood to reason that inhibiting the sympathetic nervous system via SGB might especially relieve symptoms of hyperarousal and reactivity associated with the fight-or-flight response,” said Shannon Blakey, Ph.D., a research clinical psychologist at RTI who led the analysis. “Our findings advance the field’s understanding of SBG treatment and how to use it most effectively in clinical settings.” 

Symptoms related to re-experiencing also showed pronounced response to SGB in clinician-rated but not self-reported outcomes, according to the analysis, which employed logistic regression models and other methods.

The RTI-led clinical trial, conducted from 2016 to 2018, included 113 active-duty service members experiencing PTSD symptoms who were recruited from three U.S. military hospitals. Participants were randomly assigned to receive either SGB or a placebo procedure. The SGB group received two injections of the anesthetic ropivacaine, while the placebo group received saline injections. Symptoms were assessed at baseline and eight weeks post-treatment.

The new analysis was published in May in Translational Psychiatry, a peer-reviewed medical journal from Nature Publishing Group.

View the full analysis

Learn more about RTI’s research on stellate ganglion block