Treatment of PTSD with SGB Injections

Presenting Complaint

A 45-year-old male presented to our clinic with a history of PTSD symptoms following his experience as a witness to a terrorist attack approximately 10 years ago. He reported experiencing recurrent distressing memories, nightmares, flashbacks, and hypervigilance related to the traumatic event. These symptoms had significantly impaired his daily functioning, including his ability to concentrate at work and maintain healthy interpersonal relationships. Despite receiving various forms of psychotherapy, including Eye Movement Desensitization and Reprocessing (EMDR), and pharmacotherapy over the past two years, his symptoms persisted, leading to a considerable decline in his quality of life.

Past Medical History:

The patient had no significant medical history before the traumatic event.

Social History:

The patient was employed as a sales manager and had been on long-term sick leave due to his PTSD symptoms. He lived with his spouse and had two teenage children. He reported a supportive social network of family and friends.

Previous Investigations/ Treatments

He had undergone counselling and pharmacotherapy for PTSD, including selective serotonin reuptake inhibitors (SSRIs), with minimal improvement in symptoms. EMDR therapy had been attempted but did not result in significant symptom relief. He also received input from the psychiatry team and underwent CBT without benefit.

Treatment Plan:

The patient had an online consultation with Dr Krishna for his PTSD symptoms. Given the refractory nature of his PTSD symptoms to conventional treatments, Dr Krishna recommended considering SGB injections. After discussing the risks and benefits, the patient consented to undergo Stellate Ganglion Blocks (SGB) (2 injections performed 24 hours apart), a procedure involving injection of local anaesthetic around the stellate ganglion under real-time ultrasound guidance.

Follow-up and Outcome:

Following SGB injections, the patient reported a noticeable reduction in the intensity and frequency of his PTSD symptoms within days. He described feeling more relaxed, experiencing fewer nightmares, and improved quality of sleep. Over the subsequent weeks, his symptoms continued to improve, culminating in near-complete remission of his PTSD at the 3-month follow-up. This improvement persisted at the 6-month post-procedure assessment.

Outcome Measures:

PTSD checklist (PCL-5) scores decreased from baseline, indicating a reduction in symptom severity.

Follow-up Plan:

The patient was recommended continued psychological support including trauma-focused therapy to address any residual symptoms and promote long-term recovery.

Discussion:

Stellate Ganglion Block (SGB) has emerged as a promising intervention for the treatment of PTSD, particularly in cases refractory to conventional therapies. The successful outcome observed in this case, despite prior attempts with various therapies including EMDR and psychiatric input, highlights the potential efficacy of SGB as an adjunctive treatment for PTSD. The mechanism of action is thought to involve modulation of the sympathetic nervous system, leading to a reduction in hyperarousal and reactivity associated with PTSD.

Conclusion:

This case report illustrates the successful treatment of PTSD symptoms in a 45-year-old male witness to a terrorist attack using Stellate Ganglion Block (SGB) injections. The significant improvement in symptoms following SGB underscores the potential role of this intervention in the management of refractory PTSD, even in cases where other therapies have been unsuccessful. Further research is warranted to elucidate the optimal timing, dosing, and long-term efficacy of SGB in this population.