Study Characteristics

Seven studies met the inclusion criteria. Protocols varied widely between the studies, with some offering unilateral SGB while others offered multiple bilateral SGB over several weeks. There was also a disparity with each study’s follow up period. No study had a control group for comparison. Most symptoms and subsequent improvements were self-reported with some exceptions as outlined below (Table 1). Symptoms were also organized by number of papers that studied that symptom and gross efficacy after SGB intervention represented by a pooled percentage of patients that reported benefit (Table 2).

Table 1 Various symptoms assessed after stellate ganglion blocks with relevant papers, their corresponding treatments and their reported outcomesTable 2 Condensed table of all assessed symptoms, with count of relevant papers and gross efficacy, reported as a pooled percentage of patients that reported benefit after the intervention. The symbol * designates a “highly responsive” symptom, which is defined as a symptom which is reported in at least three of the included studies with at least 60% of all study participants reporting improvement in this domainSymptomsSymptom Cluster 1: Cognitive and Psychiatric

Brain fog, depression/mood changes, anxiety, and PTSD were evaluated by 3, 4, 4, and 1 studies showing 71.6%, 69.2%, 68.6% improvement, and no significant improvement, respectively. Tools such as BrainCheck, SF-36, GAD-7, PCL-5 were utilized to determine improvement in selected manuscripts; otherwise improvements were all self-reported.

Symptom Cluster 2: Pain

Chest pain, headache, pain interference/intensity, joint pain, pins and needles were evaluated by 2, 2, 1, 1, and 1 studies showing 60%, 81.3%, 81.3%, 93.8%, and 100% improvement respectively. Tools such as PROMIS-29 pain subscores were utilized to determine improvement in selected manuscripts; otherwise improvements were all self-reported.

Symptom Cluster 3: Energy

Fatigue, post-exertional malaise, and sleep were evaluated by 6, 3, and 5 studies showing 69.8%, 56.3%, 72.2% improvement respectively. Tools such as SF-36, PROMIS-29 sleep subscores, and SleepImage System ring sleep assessments of wakefulness after sleep onset, total sleep time, percent REM sleep, sleep fragmentation, and sleep apnea were utilized to determine improvement in selected manuscripts; otherwise improvements were all self-reported.

Symptom Cluster 4: Neurological

Changes in smell/taste, autonomic dysfunction, and dizziness were evaluated by 4, 4, and 3 studies showing 55.8%, 76.7%, and 70% improvement respectively. Tools such as the COMPASS-31 and heart rate measurements were utilized to determine improvement in selected manuscripts; otherwise improvements were all self-reported.

Symptom Cluster 5: Respiratory

Cough and dyspnea were evaluated by 1 study showing 80% and 88.2% improvement, respectively. All improvements were self-reported.

Symptom Cluster 6: Miscellaneous

Cortisol level, GI symptoms, subjective relief, rash, fever, and menstrual cycle changes were evaluated by 1, 2, 2, 1, 1, 1 studies showing no significant change, 64.3%, 88%, 100%, 100%, 80% improvement, respectively. Tools such as morning salivary cortisol were utilized to determine improvement in selected manuscripts; otherwise improvements were all self-reported.