Bilateral SGB for PTSD: Why Patients Benefit from Treatment on Both Sides
Updated: Jun 26
For years, right-sided Stellate Ganglion Block (SGB) has been the standard approach for treating PTSD. But what happens when a patient doesn't respond?
A 2022 retrospective study by Mulvaney and colleagues explored this important question and found that some patients who did not improve after a right-sided SGB experienced substantial improvement after receiving a left-sided SGB instead. These findings suggest that laterality matters and that treatment should be tailored to the individual rather than relying on a one-size-fits-all approach.
Study Overview
Researchers reviewed 205 patients treated with SGB for PTSD symptoms. Patients who failed to achieve a clinically meaningful improvement after a right-sided SGB were offered a left-sided (Bilateral SGB) treatment at least 24 hours later. The primary outcome was a change in PTSD symptoms using the PTSD Checklist for DSM-5 (PCL-5).
Key Findings for Bilateral SGB
Among the patients who did not respond to an initial right-sided SGB:
90% responded favorably after a left-sided SGB.
The average PCL-5 score improved by 28.3 points, representing a clinically meaningful reduction in PTSD symptoms.
These findings suggest that a subset of patients may have differences in autonomic nervous system function that make left-sided treatment more effective.
Why This Study Matters
This paper challenged the long-standing assumption that right-sided SGB should always be the preferred treatment for PTSD.
Instead, it supports a more personalized approach to sympathetic nervous system treatment. Rather than labeling someone a "non-responder" after one procedure, clinicians may consider whether treatment on the opposite side could provide meaningful benefit.
Today, many experienced physicians have expanded on this concept by individualizing treatment based on patient presentation and emerging evidence.
At Reset Medical & Wellness Center, this philosophy is reflected in our bilateral, dual-level Neuro Sympathetic Reset (NSR) protocol, which is designed to address sympathetic dysregulation more comprehensively.
Study Limitations
Like many early studies, this research has several limitations:
It was a retrospective review rather than a randomized controlled trial.
Only 10 patients completed both right- and left-sided treatments for analysis.
Follow-up was limited to one week after treatment.
Participants were not randomly assigned, so larger prospective studies are still needed.
These limitations do not diminish the importance of the findings, but they do mean the results should be interpreted within the context of the study design.
Clinical Perspective
This study represents another important step in understanding that PTSD treatment should be individualized. While additional research is needed, the findings suggest that patients who do not improve after a right-sided SGB should not necessarily be considered treatment failures. Instead, they may benefit from a different procedural approach.
At Reset Medical & Wellness Center, we continue to follow the evolving evidence while refining our physician-led approach to nervous system treatment through trauma-informed, evidence-based care. If you are interested in learning more, having a free consultation, or starting your healing journey, complete our intake form online today.
Link to the Complete Journal Article
Michael J. Louwers, M.D.
Medical Director & CEO, Reset Medical & Wellness Center
At Reset Medical & Wellness Center, we are committed to advancing trauma-informed, evidence-based care through ongoing research, patient education, and innovative approaches to nervous system recovery.
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