We typically start with a right sided SGB block because most people appear to be right dominant when it comes to which tract is used more frequently. Both blocks can be safely done on the same day.

• natural killer cell activity reduction
• decrease in levels of inflammatory cytokines such as IL-1, IL-4, IL-6, IL-8, and TNF-α
• increase of anti-inflammatory cytokine IL-10 and calcitonin gene-related peptide (CGRP)
• regulate endothelial dysfunction
• regulate microcirculation
• regulate coagulopathy 
• reduction of neurogenic pulmonary edema
• reduce pulmonary arterial hypertension 
• reduction of pathological positive feedback loops 

The Stellate Ganglion Block (SGB) is a medical procedure used to treat symptoms of long COVID by targeting the sympathetic nervous system. The procedure involves injecting an anesthetic near the stellate ganglion, a nerve bundle in the neck, to block nerve signals that may be contributing to persistent symptoms like fatigue, brain fog, and loss of smell or taste. By modulating the nervous system, SGB helps to rebalance the body’s response and alleviate these chronic symptoms, offering relief to many patients suffering from long COVID.

After SGB treatment, when your sense of smell (anosmia) and taste (dysgeusia) get better, it’s because the treatment restores the balance between two parts of your nervous system. This happens by blocking the overactive sympathetic part in your neck, which is responsible for head and neck functions. It’s possible that when this sympathetic part is too active, it disrupts important cranial nerves like the ones for smelling, facial movement, and taste perception, causing these issues.

Timing is crucial when using a treatment called SGB for long COVID-19 syndrome. If we wait too long, the body’s adjustment to the condition may make SGB less effective. It’s like dealing with a stubborn door. The longer you wait, the harder it is to keep it open. We’ve noticed that when SGB is delayed in people with other long-lasting post-viral conditions like Lyme disease or chronic fatigue syndrome, it doesn’t work as well compared to those with long COVID-19. They only see a small improvement, about 10-20%, with each injection.

Numerous research studies have demonstrated the effects of SGB in the modulation of the immune system and hyperinflammation.

86% of participants saw some improvement of their symptoms.

41 patient study of SGB effectiveness: Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study

Because the sympathetic and parasympathetic are on opposite ends of a see-saw, when sympathetic tone decreases, the vagus nerve tone increases. 

It is a group of nerves located on each side of your cervical-thoracic vertebrae (the bones in your neck and chest part of your spine).  Signals from the brain stop there before going to the rest of your body.  Information for this ganglion is also relayed to the rest of the body including the face, brain, head, neck, arms, and chest.  You have one of these on each side of your neck.

It is a way to interrupt the signals going in and out from the stellate ganglion by numbing the ganglion with a local anesthetic such as lidocaine, ropivacaine, or bupivacaine.  This is performed under live ultrasound guidance at least in practice, but it can also be performed with fluoroscopy or live x-ray guidance.  This procedure is an injection but it is tolerated very well even awake.  We also block the C3 or C4 area which contains the superior cervical plexus and the sympathetic tract or road to the brain.  This is not technically part of the actual SGB, but has been shown to improve results by Dr. Eugene Lipov, MD.

SGB stands for Stellate Ganglion Block.  It is an injection that is performed in the neck area to treat the dysautonomia cause of long covid.

Assuming the SGB was safely performed by an experienced provider such as the ones we perform in our clinic, we expect and want to see the Horner’s syndrome.  This is a constellation of signs that show up almost immediately after the block is completed.  You may also feel a lump in your throat, hoarseness, loss of voice, or difficulty swallowing for the duration of the effects of the block.  This is not caused by the SGB, but by the inadvertent numbing of one of the vocal cord nerves called the recurrent laryngeal nerve.  This is not dangerous as long as both sides of your neck are numbed at the same time.

We don’t target the symptoms but the actual source of the problem, the dysautonomia.  What we have seen respond best to the SGB is smell and taste abnormalities including anosmia (no smell), parosmia (abnormal, and hyposmia, but not phantosmia), brain fog, anxiety, depression, and chronic fatigue.