Abstract: Aim: This study aimed to evaluate the efficacy and safety of ultrasound-guided stellate ganglion block (SGB) for the relief of post-traumatic stress disorder (PTSD) symptoms in patients with treatment-resistant PTSD.

Materials & Methods: This prospective observational study included 50 patients aged 18–65 years, diagnosed with PTSD based on DSM-5 criteria. Patients with persistent PTSD symptoms despite psychotherapy or pharmacotherapy were included, while those with coagulopathy, local infections, allergies to anesthetics, or severe comorbidities were excluded. Bilateral SGB was performed under ultrasound guidance, using a 22-gauge needle and injecting 6 mL of 0.25% bupivacaine. The procedure was repeated on the contralateral side after 7 days. Outcomes were assessed using the Clinician-Administered PTSD Scale (CAPS-5), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7) scale, and Global Assessment of Functioning (GAF) at baseline, 2 weeks, 1 month, 3 months and 6 months.

Results: The study included 50 patients (mean age 38.2 ± 10.4 years, 60% male), all of whom had prior psychotherapy and 80% had received pharmacotherapy. Significant reductions in PTSD symptoms (CAPS-5 scores from 47.6 ± 8.2 to 24.5 ± 5.2 at 6 months, p < 0.01), sleep disturbances (PSQI scores from 14.2 ± 3.1 to 7.6 ± 2.1, p < 0.01), and anxiety levels (GAD-7 scores from 15.8 ± 4.6 to 7.4 ± 3.1, p < 0.01) were observed. Functional improvement (GAF scores from 45.7 ± 7.5 to 69.7 ± 8.8, p < 0.01) and high satisfaction levels were reported. Adverse events were minimal and included local pain (10%), mild dizziness (6%), and transient hoarseness (4%). No serious complications occurred.

Conclusion: Ultrasound-guided SGB demonstrated significant efficacy in reducing PTSD symptoms, improving sleep quality, and alleviating anxiety, with sustained benefits up to three months. The procedure was well-tolerated, with a low incidence of minor adverse effects, making it a safe and effective adjunctive treatment for treatment-resistant PTSD.