Two very different procedures aimed at the same problem
If you have been researching PTSD treatment beyond therapy and daily medication, two names come up often: stellate ganglion block (SGB) and IV ketamine. Both are procedures rather than pills. Both have produced rapid improvement for some people in studies. Both are used off-label for PTSD. Beyond that, they have little in common.
SGB targets the body’s stress wiring in the neck. Ketamine targets glutamate signaling in the brain. No trial has compared them head to head, so any comparison relies on separate studies in different groups of people. Neither replaces trauma-focused therapy such as Prolonged Exposure, Cognitive Processing Therapy, or EMDR, which remain first-line under the 2023 VA/DoD guideline. Our overview of PTSD treatment options in Nashville covers the full range.
A disclosure up front: Music City Ketamine provides IV ketamine. We do not perform stellate ganglion blocks. We have tried to describe SGB fairly, and for some people it may be the better fit.
How a stellate ganglion block works
The stellate ganglion is a cluster of sympathetic nerves at the base of the neck, part of the system that drives fight-or-flight responses. In an SGB, a physician, usually an anesthesiologist or pain specialist, injects local anesthetic beside this cluster, typically on the right side, using ultrasound or fluoroscopy for guidance. Cleveland Clinic describes the injection as taking less than 30 minutes, followed by roughly 40 to 60 minutes of monitoring.
How this helps PTSD is not settled. A 2021 rapid review by the Canadian Agency for Drugs and Technologies in Health (CADTH) noted that the stellate ganglion connects to the amygdala, a region thought to be overactive in PTSD, but described the mechanism as incompletely understood. The working hypothesis is that briefly interrupting sympathetic signaling lets an overactive threat system settle. Some clinics add a second block higher in the neck; a 2026 review in Current Psychiatry Reports (Bielawiec and colleagues) found that approach appears safe but not clearly more effective than a single right-sided block.
How IV ketamine works
Ketamine is an NMDA receptor antagonist. At the low doses used in mental health care, it triggers a surge of glutamate signaling and downstream effects, including increased BDNF, that are associated with new synaptic connections in the prefrontal cortex and hippocampus. Researchers think this may loosen rigid fear and threat patterns and open a period in which new learning, including therapy, can take hold. We describe that idea in the neuroplastic window.
The infusion runs about 40 minutes through an IV, with a dreamlike or dissociative quality that fades soon after it ends. Many patients begin with six infusions over two to three weeks. Ketamine is FDA-approved as an anesthetic; its use for PTSD is off-label.
What the research shows for each
SGB. The strongest evidence is a 2020 randomized trial in JAMA Psychiatry (Rae Olmsted and colleagues). It assigned 113 active-duty service members, two to one, to SGB or a sham procedure, with two injections two weeks apart. At eight weeks, CAPS-5 scores fell 12.6 points with SGB versus 6.1 with sham. The authors noted mild-to-moderate baseline symptoms and short follow-up. A 2024 secondary analysis in Translational Psychiatry (Blakey and colleagues) found the largest effects in arousal and reactivity symptoms: hypervigilance, trouble concentrating, and sleep disturbance.
The picture is not all positive. A 2016 trial of 42 service members in Regional Anesthesia and Pain Medicine (Hanling and colleagues) found no meaningful difference between SGB and sham. Much of the enthusiasm comes from case series, such as a 2014 report in Military Medicine (Mulvaney and colleagues) in which over 70% of 166 service members improved, but case series have no control group. The VA/DoD guideline found insufficient evidence to recommend for or against SGB, and a larger multisite placebo-controlled trial in veterans is under way.
IV ketamine. A 2014 crossover trial in JAMA Psychiatry (Feder and colleagues) found that a single ketamine infusion reduced PTSD symptoms more than midazolam at 24 hours in 41 patients. A 2021 trial in the American Journal of Psychiatry gave 30 patients six infusions over two weeks: 67% responded on ketamine versus 20% on midazolam. But a 2022 trial in Neuropsychopharmacology (Abdallah and colleagues) of 158 veterans and service members found no significant PTSD benefit from eight infusions, though the standard dose improved depression. The VA/DoD guideline suggests against ketamine for PTSD.
Both evidence bases are small, mixed, and drawn heavily from military populations. Neither has a clear edge. Our article on ketamine for PTSD covers the ketamine research in more depth.
Speed, durability, and what the process involves
| Factor | Stellate ganglion block | IV ketamine |
|---|---|---|
| What it targets | Sympathetic nerves in the neck | NMDA glutamate receptors in the brain |
| Who delivers it | Anesthesiologist or pain physician, with imaging guidance | Anesthesia-trained clinician; at MCK, CRNA-led |
| Typical course | One or two injections; the 2020 RCT used two, two weeks apart | Often six infusions over two to three weeks |
| Time per visit | Injection under 30 minutes, plus monitoring | About 40-minute infusion, plus recovery |
| Onset in studies | Rapid relief reported in case series; RCT outcome at 8 weeks | Within 24 hours (Feder 2014) |
| How long benefit lasted | RCT followed 8 weeks; reviews describe up to 3–6 months | Median 27.5 days to loss of response (Feder 2021) |
| VA/DoD 2023 | Insufficient evidence for or against | Suggests against |
| Offered at Music City Ketamine | No | Yes |
Durability is where expectations most often go wrong. For SGB, the 2026 Current Psychiatry Reports review describes effects lasting up to three to six months in some people, with repeat blocks possible, but the controlled evidence covers only eight weeks. For ketamine, benefits after a two-week series often faded within about a month in the 2021 trial, and some patients continue with periodic maintenance infusions. For both, therapy is what tends to make gains last.
Risks and side effects
SGB. Temporary effects are common and usually resolve within hours: a drooping eyelid and red eye on the injected side (Horner syndrome), hoarseness, a lump-in-the-throat feeling or trouble swallowing, and warmth in the arm. The CADTH review reported low adverse event rates in the randomized trials, with self-resolving effects such as injection-site pain and eye drooping. Rare but serious risks include bleeding, infection, nerve injury, and a collapsed lung.
IV ketamine. Common effects include dissociation, a temporary rise in blood pressure and heart rate, nausea, and dizziness. In the 2022 Neuropsychopharmacology trial, dissociative effects returned to baseline within two hours and lessened with repeated doses. Ketamine is not right for everyone, including some people with uncontrolled high blood pressure, certain heart conditions, or a history of psychosis; our article on when we decline ketamine for a patient explains why.
At Music City Ketamine, Marla Peterson, CRNA, oversees every infusion, with anesthesia-level monitoring throughout, and a clinician is in the room. The infusion can be slowed or paused. More detail is in is ketamine therapy safe?
Cost and access in Middle Tennessee
SGB is offered by some pain-management and anesthesia practices rather than mental health clinics. Clinics that publish self-pay prices for PTSD-focused SGB commonly list roughly $1,000 to $2,000 or more per treatment, and many insurers do not cover it for PTSD. If you are pricing SGB, ask whether the quote includes imaging, facility fees, and a second injection.
At Music City Ketamine, infusions are $475 each, so a six-infusion series is $2,850. Insurance generally does not cover off-label ketamine. Veterans may want to ask their VA care team what is available to them, and our article on ketamine for veterans covers common questions.
Who might fit which, and why they are not mutually exclusive
There is no test that predicts who will respond to either. Still, some patterns are worth discussing with a clinician. SGB may appeal to people whose symptoms center on hyperarousal, such as startle, hypervigilance, and poor sleep; who prefer one or two brief visits; or who would rather avoid an altered state. Ketamine may appeal to people with significant depression alongside PTSD, those who prefer to avoid a neck injection, or those who want a medicine that may pair with ongoing therapy, as described in ketamine and EMDR integration.
They are not either/or. SGB and ketamine act on different systems, and some people try one and later the other. There is little research on combining them, so if you are considering both, tell each clinician about the other and plan the timing together. If you choose SGB elsewhere, we are glad to coordinate with that provider, with your written consent. Our PTSD and trauma pages gather related resources, including what trauma-informed ketamine care looks like and ketamine for complex PTSD. If you are in crisis, call or text 988; veterans can press 1.