Stellate Ganglion Block (SGB): What the Evidence Supports
A stellate ganglion block is an injection of local anesthetic near the sympathetic nerve cluster in the lower neck, placed under image guidance. It is needle-only, requires no surgical incision, and is performed as a day case. The strongest evidence sits with selected pain conditions. At YOUNIFY Clinic the procedure starts from THB 37,500. Results vary by individual.
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Doctors
Dr. Rarinthorn Choomsai Na Ayuthaya
Pain Medicine / Anesthesiologist
Diploma of Pain Medicine
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Key takeaways
- The block is temporary by design. It reduces sympathetic signaling for a period, and it does not destroy the nerve.
- The level of evidence differs by indication, and this page sets it out before you decide rather than after.
- The procedure is needle-only, performed under ultrasound or X-ray guidance, and carried out as a day case.
- Short-lived effects such as a drooping eyelid or a warm hand on the treated side are expected, and they confirm that the anesthetic reached the target.
- The starting price is THB 37,500. The final plan and quotation follow a physician consultation.
What the procedure is
The autonomic nervous system has two sides that balance one another. One of them, the sympathetic nervous system, prepares the body to respond to stress and to threat. The stellate ganglion is the cluster of sympathetic nerves in the lower neck through which signals travel to the head, the neck, and the arm.
Placing local anesthetic near that cluster reduces sympathetic signaling for a period, which allows your physician to observe how your symptoms respond. This is not a procedure that destroys tissue, but a temporary block whose effect wears off as the anesthetic clears.
Indications, set out by level of evidence
| Indication | Where the evidence stands | What your physician will tell you |
|---|---|---|
| Complex regional pain syndrome (CRPS) | The most studied indication, although the systematic review of local anesthetic sympathetic blockade rates the quality of evidence as low to very low | A reasonable option inside a wider care plan, rather than a standalone treatment |
| Nerve-related pain of the head, neck, and arm | Long-standing use in clinical practice, with procedural references supporting technique and indications, and no large randomized trial | Considered individually, and usually combined with other care |
| Circulation problems in the arm | The original indication for the procedure | Considered according to the underlying cause in each case |
| Sleep quality | A 2026 meta-analysis (7 studies, 440 participants) found longer sleep and better sleep quality scores, although most participants were surgical patients and follow-up was short. | An add-on option after the cause of poor sleep has been assessed; guidelines still recommend cognitive behavioral therapy for insomnia first. |
| Sleep in stress, anxiety, or depression | No high-quality studies yet in people diagnosed with an anxiety disorder or depression. | Considered case by case to support sleep, alongside psychiatric care, not as a treatment for the condition. |
| Posttraumatic stress disorder (PTSD) | A 2020 randomized trial (113 participants) found greater symptom reduction than sham over eight weeks, while a 2016 randomized trial (42 participants) found no significant difference. | An add-on option alongside therapy and medication, not a replacement. |
We publish this table because knowing how strong the evidence is for your own indication is what allows you to decide for yourself, not because of a claim in an advertisement.
How the procedure works
Performed by an anesthesiologist at YOUNIFY Clinic, medical facility licence 10101005069.
- Assessment. History, examination, a full medication review including anticoagulants and supplements, and an agreement on how the result will be measured.
- Positioning. You lie on your back with the neck slightly extended, and the skin is cleaned.
- Needle placement under image guidance. Ultrasound or X-ray is used to avoid the important structures in the neck and to confirm the position before anything is injected.
- Injection of local anesthetic in the volume your physician has planned.
- Observation afterward. Vital signs and the expected short-lived effects are checked before you go home.
- Follow-up to decide together whether to continue or to change the plan.
The procedure is short, requires no general anesthesia, and requires no overnight stay. The equipment used meets recognized international standards.
Expected short-lived effects
The following are signs that the anesthetic reached the intended target, and they settle as the block wears off.
- Slight drooping of the eyelid on the treated side
- Redness of the eye, or briefly blurred vision
- Nasal congestion on one side
- A feeling of warmth in the hand and arm on that side
- Temporary hoarseness
- Mild, temporary difficulty swallowing
Your physician explains all of these before the procedure so that they do not come as a surprise.
Risks we explain in full
The neck contains several important structures close together, which is why image guidance is used. The risks we discuss include the following.
- Pain, bruising, or swelling at the needle site
- Hoarseness or difficulty swallowing that lasts longer than expected
- Bleeding under the skin of the neck
- Uncommon risks, including anesthetic reaching an unintended location, effects on breathing, and infection
- No change in symptoms at all, which is a possible outcome and one we discuss before you decide
When the block is not the right step
- Infection of the skin over the neck, or an untreated infection elsewhere
- A bleeding disorder, or anticoagulant medication that has not been reviewed with the prescribing physician
- Breathing or lung conditions that raise the risk
- Previous neck surgery or radiotherapy that has significantly altered the anatomy
- Pregnancy, which is assessed individually
- Known allergy to local anesthetic
Price
| Item | Starting price (THB) |
|---|---|
| Stellate ganglion block (SGB) | 37,500 |
This is a starting price. The number of sessions that suits your case, and the final cost, are confirmed in a written quotation after a physician consultation.
Sources
- O'Connell NE, Wand BM, Gibson W, Carr DB, Birklein F, Stanton TR. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews. 2016.
- Peterson K, Bourne D, Anderson J, Mackey K, Helfand M. Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD). Department of Veterans Affairs (US). 2017.
- Piraccini E, Munakomi S, Chang KV. Stellate Ganglion Blocks. StatPearls, StatPearls Publishing.
- Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021.
- Wu J, et al. A novel application of stellate ganglion block to improve sleep: a systematic review and meta-analysis. Frontiers in Psychiatry. 2026;17:1753003. doi:10.3389/fpsyt.2026.1753003
- Rae Olmsted KL, et al. Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: a randomized clinical trial. JAMA Psychiatry. 2020;77(2):130-138. doi:10.1001/jamapsychiatry.2019.3474
- Hanling SR, et al. Stellate ganglion block for the treatment of posttraumatic stress disorder: a randomized, double-blind, controlled trial. Regional Anesthesia and Pain Medicine. 2016;41(4):494-500. doi:10.1097/aap.0000000000000402
Read next in this series
Frequently asked questions
What is a stellate ganglion block?
It is an injection of local anesthetic near the sympathetic nerve cluster in the lower neck, placed under image guidance, which temporarily reduces sympathetic signaling so that your physician can observe how your symptoms respond.
How much does it cost in Bangkok?
At YOUNIFY Clinic the procedure starts from THB 37,500. The final plan and the written quotation follow a physician consultation, and the number of sessions is decided individually.
How long does the appointment take, and do I stay overnight?
The procedure itself is short, no general anesthesia is required, and no overnight stay is needed. You are observed for a period afterward, and most patients go home the same day.
Is it painful?
Local anesthetic is used at the needle site. Most patients describe pressure rather than sharp pain, and some soreness at the site for a short period afterward.
What will I feel straight afterward?
Usually the short-lived effects listed above, which confirm that the anesthetic reached the target. They settle as the block wears off.
How many sessions will I need?
There is no fixed number. Your physician decides according to the indication and to how you respond to the first block, and you agree in advance how the result will be measured.
How long does the effect last?
The anesthetic itself is temporary. What happens to symptoms after that varies by individual and by indication, so it is assessed together after the first session rather than promised in advance.
Does it help with sleep?
The evidence for sleep and stress-related symptoms remains limited, and the sleep medicine guideline places cognitive behavioral therapy for insomnia first. We assess what is driving your sleep before considering anything else.
Do I need to stop my blood thinner?
Tell us about every medication and supplement you take. Whether a medication is paused, and for how long, is decided by your physician together with the doctor who prescribed it. Never stop a prescribed medication on your own.
Will my insurance cover it?
That depends on your policy and on the clinical indication. Our team prepares a treatment summary you can submit, although approval remains the decision of your insurer.
YOUNIFY Clinic · 2nd Floor, Room 214, United Center Building, 323 Silom Road, Silom, Bang Rak, Bangkok 10500, Thailand · Near BTS Sala Daeng (5-min walk) · Open daily 11:00–20:00
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Medically reviewed by Dr. Noppachai Siranart · Last reviewed
Individual results may vary. Please consult a doctor before treatment.