{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:40:12Z","timestamp":1789404012310,"version":"build-2803163510"},"reference-count":4,"publisher":"Oxford University Press (OUP)","issue":"7-8","license":[{"start":{"date-parts":[[2024,7,13]],"date-time":"2024-07-13T00:00:00Z","timestamp":1720828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Describe a 2-patient case report of a rare occurrence of significantly increased anxiety after a left-sided stellate ganglion block (SGB) and the subsequent improvement of that anxiety through a right-sided SGB. Right-sided SGB to treat post-traumatic stress disorder (PTSD) has over 23 supporting publications in the peer-reviewed medical literature, including level 1 evidence. A published case series of 285 patients showed that two-level SGB may improve anxiety-related symptoms in patients. However, a recently published study indicates that some patients only respond to a left-sided SGB. The patients had an ultrasound-guided right-sided SGB for the treatment of PTSD and experienced a reduction in anxiety symptoms based on Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores. Later, a left-sided SGB was performed. Clinically, the addition of a left-sided SGB is typically associated with further anxiety reduction, but in these 2 cases, the patients had a significant reversal of the improvements experienced after a right-sided SGB. Following this unusual response to a left-sided SGB, these patients were offered another right-sided SGB, after which, they experienced a significant and durable improvement in anxiety symptoms beyond the original baseline PCL-score. In rare cases and for unknown reasons, a left-sided SGB may result in acute worsening of anxiety symptoms, which can be addressed and significantly improved with the application of a subsequent right-sided SGB.<\/jats:p>","DOI":"10.1093\/milmed\/usae338","type":"journal-article","created":{"date-parts":[[2024,7,13]],"date-time":"2024-07-13T04:36:48Z","timestamp":1720845408000},"page":"e1742-e1744","source":"Crossref","is-referenced-by-count":5,"title":["Reversible Increased Anxiety Following Left-Sided Stellate Ganglion Block to Treat Posttraumatic Stress Disorder: A Case Report"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8762-2835","authenticated-orcid":false,"given":"Sean W","family":"Mulvaney","sequence":"first","affiliation":[{"name":"Regenerative Orthopedics and Sports Medicine , Annapolis, MD 21401,","place":["USA"]},{"name":"Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James H","family":"Lynch","sequence":"additional","affiliation":[{"name":"Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary E","family":"Means","sequence":"additional","affiliation":[{"name":"Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle J","family":"Dineen","sequence":"additional","affiliation":[{"name":"Regenerative Orthopedics and Sports Medicine , Annapolis, MD 21401,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Mahadevan","sequence":"additional","affiliation":[{"name":"Regenerative Orthopedics and Sports Medicine , Annapolis, MD 21401,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,13]]},"reference":[{"issue":"2","key":"2025070106314072400_R1","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1001\/jamapsychiatry.2019.3474","article-title":"Effect of the stellate ganglion block treatment on posttraumatic stress disorder symptoms; a randomized clinical trial","volume":"77","author":"Rae-Olmstead","year":"2020","journal-title":"JAMA Psychiat"},{"issue":"3","key":"2025070106314072400_R2","article-title":"Comparison C6 stellate ganglion versus C6 and C4 cervical sympathetic chain blocks for treatment of posttraumatic stress disorder (PTSD): analysis of 147 patients","volume":"7","author":"Mulvaney","year":"2020","journal-title":"J Neurol Disord Stroke"},{"issue":"2","key":"2025070106314072400_R3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.55460\/EQ05-H5TO","article-title":"Clinical guidelines for stellate ganglion block to treat anxiety associated with post-traumatic stress disorder","volume":"15","author":"Mulvaney","year":"2015","journal-title":"J Spec Oper Med"},{"issue":"7\u20138","key":"2025070106314072400_R4","doi-asserted-by":"publisher","first-page":"e826","DOI":"10.1093\/milmed\/usab056","article-title":"The successful use of left-sided stellate ganglion block in patients that fail to respond to right-sided stellate ganglion block for the treatment of posttraumatic stress disorder symptoms: a retrospective analysis of 205 patients","volume":"187","author":"Mulvaney","year":"2022","journal-title":"Mil Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/7-8\/e1742\/58531542\/usae338.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/7-8\/e1742\/58531542\/usae338.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:31:48Z","timestamp":1751365908000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/7-8\/e1742\/7713061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,13]]},"references-count":4,"journal-issue":{"issue":"7-8","published-online":{"date-parts":[[2024,7,13]]},"published-print":{"date-parts":[[2025,6,30]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae338","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2024,7,13]]}}}