title: 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.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Consortium for Health and Military Performance, Uniformed Services University, Bethesda, Maryland 20814, USA. seanmulvaney@hotmail.com
authors.forename: Sean W
authors.initials: SW
authors.lastname: Mulvaney
authors.forename: Brian
authors.initials: B
authors.lastname: McLean
authors.forename: Jason
authors.initials: J
authors.lastname: de Leeuw
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000628:therapy*; D001340:Autonomic Nerve Block / Q000379:methods*; D003130:Combat Disorders / Q000150:complications*; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011594:Psychometrics / Q000379:methods; D013233:Stellate Ganglion / Q000502:physiology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000209:etiology*