Ashmore Osteopathic Group

Specific risks pertaining to the SGB procedure have been discussed and I am fully aware of the adverse effects as indicated. I have been provided with written and verbal information about the availability of the procedure as a method to help manage sympathetic arousal symptoms. In addition, risks and potential benefits of SGB were discussed.

Medications:

Your medical history will be discussed, in particular any allergies, anticoagulant medications or antidepressants such as SSRI’s (Cipramil, Prozac, Zoloft) or Benzodiazepines (Xanax, Valium, Ativan).

Side effects of the procedure include:

The stellate ganglion block is a safe procedure that has been in wide medical use since the 1950’s. It is an injection in the side of the neck done with ultrasound to inject a long-acting local anaesthetic around the main nerve that controls the “fight or flight” response (the sympathetic nervous system). Done properly, it is consistently described by my patients as a “1 out of 10” for pain. Multiple peer-reviewed medical studies show that a right- sided SGB results in significant long-term improvement in chronic anxiety symptoms associated with post-traumatic stress disorder (PTSD).

• What to expect and how to prepare for an SGB

On the day of the procedure, wear a top that can be removed or will completely clear the right shoulder and neck. Remove any necklaces or large earrings. Plan on taking it easy for the rest of the day. Your right eye will look droopy for about 5-7 hours.

• What happens during the SGB procedure?

First, the procedure will be discussed to make sure this is an appropriate procedure for you and you, the potential benefits and the potential risks; this is called informed consent and is done before every medical procedure. Let the treating practitioner know if you have any allergies to medicines. You will lay face up on a comfortable treatment table with your right shoulder and neck exposed. An intravenous cannula is inserted into the vein of the arm, then flushed with saline. The skin on the shoulder and neck will be cleaned with a surgical skin preparation called Chloroprep and sterile ultrasound gel applied to the neck. The area over and around the 6th cervical vertebra will be scanned with ultrasound and Doppler ultrasound and the anatomic landmarks identified. Once the landmarks are identified, a small amount of local anaesthetic will be placed just under the skin to make the procedure more comfortable. Using real-time ultrasound guidance, the needle will be guided alongside the stellate ganglion (the cervical sympathetic chain), which controls the body’s “fight or flight” response. Once the needle is at the target, 4ml a long-acting anaesthetic called ropivacaine will be slowly injected over 2-3 minutes. Aspiration tests are done before injection, precautionary measures are in place in case of respiratory failure (oxygen, ventilating devices). We do not perform the SGB procedure without a GP/nurse practitioner present.

Anticonvulsant, anticholinergic and antispasmodic agents are also kept on hand. An intravenous line is put in place prior to SGB procedure and vital signs are monitored routinely. During the injection you will be asked if you are doing ok; it is safe to answer. Let your practitioner know if you are having a metallic taste in your mouth, if there is ringing in your ears, or if you just feel weird. Once the needle is withdrawn, a coverplast will be placed at the injection site. You will continue to lay flat for 20 minutes, then you will sit up and have your SGB assessed. When the sympathetic nerves are blocked, it results in a temporary condition referred to as a “Horner’s syndrome”.

Example of a Horner’s Syndrome on the right side

Your eyelid will be droopy, your pupil will get smaller than the other pupil, and the white part of your eye may get red. This is a normal part of the block and will wear off in 5-7 hours. In about 15% of the cases, patients also experience a “hoarse voice” or feel as if something is in the back of their throat. This occurs if the local anaesthetic used to perform the block spreads and blocks another nerve to the larynx. This is not a mistake, it just happens sometimes and is temporary like the Horner’s syndrome. If this happens, take a few careful sips and make sure you are swallowing normally.

• What to do after your procedure:

Generally, patients report only mild soreness which does not require any treatment. Although complications are very rare, pain that is getting worse in your neck or shortness of breath could be signs of a serious complication, contact our office (07) 5597 5711. Avoid showering or immersion in water for the rest of the day of the procedure. The coverplast bandage can be removed after a few hours. Most people feel the results of the injection within an hour.

Keep track or diary of the symptoms that were bothering you and see what differences you notice. Many properly selected patients get sustained relief of their symptoms and do not need further treatment, but in some patients, symptoms may be re-triggered and re-occur. If this happens and the block helped you previously, the SGB may be repeated. Don’t let your symptoms fully return before seeking treatment. If you notice a regression of your symptoms contact our office. In the published medical literature, many people get significant relief of their PTSD symptoms after a right-sided SGB. However, SGB is not intended to be a stand-alone treatment for significant PTSD or other anxiety conditions and works best when part of a treatment plan with your health provider.

The risks have been explained to my satisfaction and I accept them and consent to the SGB procedure which is performed under the guided supervised protocol of Dr. Frances Hill M.B.B.S / David Krizanic BClinSc/BOSc, Osteopath and nurse practitioner Michele Kealy RN to perform this procedure.

Signed     ______________________________________________________                      Patient or legal guardian

Date  ___________________

Medical Provider Declaration: I and/or my associates have explained the procedure and the pertinent contents of this document to the patient and have answered all the patient’s questions. To the best of my knowledge, the patient has been adequately informed and the patient has consented to the above described procedure.

Signed    ______________________________________________________                     Medical Provider’s name and Signature

Date  ___________________