I would like to comment on the placebo effect because I don't think most people understand what it means.
The effect the patient receives is real, can be curative, and can be permanent. When the placebo effect was first studied, it wasn't understood. And like most things not understood by medicine, it had to be chicanery, fake, psychological, nuts. So initially, it was thought that if a person responded to a placebo that the original issue wasn't physiologically or anatomically real.
What we know now is that the placebo effect IS real and actually works on many people and that there isn't any way except with randomized controlled trials to tease out the percentage of the effect in a group of subjects.
Placebos also have side effects - they can cause people to be drowsy, nauseated, constipated, short of breath - you name it. The side effects are real - patients actually experience nausea and vomiting for instance.
SGB needs to be studied in a large, diverse population with blinded evaluators, rigorous follow-up with standardized testing/questionaires.
I would not recommend it casually because the procedure has its own component of risks. Some of these are side effects that always happen: eyelid droops, the patient is hoarse, the feeling of not being able to breathe because the diaphragm on the blocked side doesn't work until the block wears off, and all of these feelings can make people panic. If the patient has some significant lung disease, he might even need to be intubated and placed on a ventilator.
The block can also result in injury to the lung (pneumothorax) requiring a chest tube to be placed. If the needle punctures a blood vessel (and there are several in that region) a patient can have a seizure, a stroke, bleeding into the chest (hemothorax). If the local anesthetic is accidently injected into a blood vessel, the patient can have cardiac arrest and die. If the local anesthetic is accidently injected into the spinal cord, the patient can be a quadrapelegic.
Even if the procedure is done by someone who does them routinely and is done under fluoroscopy (real time X-ray) any of those complications can occur. I read case reports in all of my journals - that is where those things typically show up. However, not every bad thing that happens to patients gets published as a case report. Case reports represent the tiniest tip of the ice berg.
Cervical epidurals were becoming more common in the past five years - and the case reports of really bad things happening increased until finally the federal government stepped in and laid down guidelines about who should get them and under what circumstances.
SGB might be a wonderful treatment for some or many or all - but until it is studied, people must realize that there are dangers. While the statistical risk for a given procedure might be estimated: in a German publication where anesthesiologists who perform stellate ganglion blocks were surveyed, the incidence of serious complications was about 2 per 1000 patients out of 45,000 SGBs, but only half of the people surveyed responded. The half who didn't respond might have had more complications than those who did respond.
Lastly - statistics are great; but if you become one of the statistics, it is 100% for you. I take clonidine every night which performs a chemical stellate ganglion block on my brain and that works for certain aspects of my PTSD problems. Even so, I would not recommend every PTSD patient be placed on clonidine. There are side effects and risks with the medicine.
