Interventional pain medicine · London
Stellate ganglion block, by a consultant in pain medicine.
An ultrasound-guided sympathetic block at C6 for CRPS, refractory angina, and selected trials in PTSD, menopausal hot flushes and long COVID. A consultant with a regular list, in a unit with full resuscitation cover, and an honest read on which indications have the evidence and which do not.
Why patients choose us
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A pain consultant with an SGB list, not a one-off booking
A named consultant in pain medicine or anaesthesia with a regular ultrasound-guided stellate list, working in a unit with resuscitation cover on the door.
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Honest about the evidence tier
CRPS and refractory angina have strong data. PTSD, menopausal hot flushes and long COVID do not. We tell you which bucket your indication sits in before you spend.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private stellate ganglion block costs in London.
Indicative ranges across our partner units. Send the indication and referral and we quote firm figures across two or three consultants.
In short
A single ultrasound-guided SGB in our London network: £850–£1,600, package of three £2,400–£4,200.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Pain consultant assessment and indication review | £250–£450 | 30–45 min | Same visit |
| Single ultrasound-guided stellate ganglion block | £850–£1,600 | 10–20 min | Same visit |
| Package of three blocks (one to two week intervals) | £2,400–£4,200 | 3 visits | 4–6 weeks |
| Second-opinion review of prior blocks and imaging | £250–£450 | 30 min | 48 hours |
Prices vary by unit, by consultant seniority, and by whether steroid is added. For PTSD and long COVID we quote as investigational and confirm that insurers will not usually reimburse.
The problem
The right consultant, the right approach, the right consent.
A stellate block done as a favour on a general anaesthetic list, without ultrasound and without a proper evidence-tier conversation, is a poor use of your money. We stop that happening.
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Is SGB even the right procedure?
For CRPS and refractory angina it is a strong candidate. For PTSD and long COVID it is investigational and only worth it after an honest chat about cost and effect size.
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Worried about the vascular risks?
Ultrasound guidance turns a landmark technique into a visualised one - the vertebral artery, carotid and thyroid are on-screen throughout.
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Want a consultant with a regular list?
A named consultant in pain medicine or anaesthesia running SGB weekly, in a unit with intralipid and full resuscitation cover on the door.
The journey
From referral to review - what happens, in order.
One team from first message to the two-week review that decides whether a series is worth doing.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A couple of hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us a short history
A confidential form. The indication (CRPS, PTSD, hot flushes, long COVID, angina), previous treatments, and any imaging or clinic letters.
- 02
Before
We come back with a recommendation
Within one working day: whether SGB is a reasonable next step, or whether the evidence and your history point elsewhere. Indicative cost either way.
- 03
Before
We arrange the procedure
Usually within one to two weeks. Anticoagulants are reviewed. You will need someone to drive you home and to avoid eating for four hours before.
- 04
On the day
Arrival and consent
Arrival, a proper consent conversation about the expected Horner’s, hoarseness and the rare vascular risks. IV access and monitoring.
- 05
On the day
The block itself
10 to 20 minutes. Supine, neck slightly extended. Ultrasound-guided anterior paratracheal approach at C6, 5 to 10 mL of 0.5% bupivacaine deposited deep to prevertebral fascia.
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On the day
Recovery and discharge
Monitored for 30 to 45 minutes. A drooping eyelid, small pupil and warm arm on the treated side confirm the block worked. Home the same afternoon.
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After
Review and, if useful, a series
A short review at two weeks. If the first block clearly helps, we plan a series of two or three at one to two week intervals. If it does not, we stop and rethink.
Typical end-to-end: 1–2 weeks to first block. Single-block effect: 1–4 weeks. Series review: 2 weeks.
When it helps
Which indications have the evidence - and which do not.
The three tiers matter. Strong RCT-backed indications, emerging ones with mixed data, and investigational uses where honest consent is the whole point.
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CRPS type I or II of the upper limb
Strong evidence tier. Sympathetically maintained pain in the hand or arm after injury, surgery or nerve damage - the flagship indication for SGB.
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Refractory angina
Strong evidence tier. Left-sided SGB reduces frequency of anginal episodes in patients maxed out on medical therapy and unsuitable for revascularisation.
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Sympathetically-mediated upper limb pain
Post-herpetic neuralgia, phantom limb pain, and post-stroke shoulder-hand syndrome where a sympathetic component is suspected.
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PTSD - investigational in the UK
Emerging tier. US military uses SGB widely; RCT evidence in civilians is mixed with a small effect on CAPS scores. We only offer it after honest consent.
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Menopausal hot flushes when HRT is off-limits
Emerging tier. RCTs show modest reduction in vasomotor symptoms in women who cannot take HRT (breast cancer survivors, high VTE risk).
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Long COVID with dysautonomia
Investigational tier. Case series suggest benefit in POTS-like symptoms and brain fog after COVID-19; no RCT data yet. Expect a candid conversation.
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Hyperhidrosis of the face and upper limb
A short-lived option for severe facial or palmar sweating - not a substitute for the definitive surgical or Botox pathways.
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Red flag: new neurological signs
Weakness, sensory loss or bowel and bladder change is not an SGB problem. That is a neurology and imaging pathway first.
Procedure options
SGB is a family of techniques - and neighbouring options sit beside it.
What each option involves. For patients who respond well but relapse quickly, pulsed RF or thoracic sympathectomy may be the more durable answer.
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Ultrasound-guided anterior paratracheal (C6)
The modern standard. Real-time imaging of carotid, thyroid, longus colli and vertebral artery - avoids the vessels and confirms spread of local anaesthetic on-screen.
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Fluoroscopy-guided C6 or C7 approach
Historic technique using X-ray landmarks and contrast. Still used in some units, particularly where deeper C7 spread is wanted, but does not visualise soft tissue or vessels.
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Bupivacaine 0.5%, 5 to 10 mL
The workhorse local anaesthetic. Longer duration than lidocaine. Larger volumes risk phrenic and recurrent laryngeal spread but improve caudal spread to T1.
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Adding a small dose of steroid
Some consultants add 20–40 mg of methylprednisolone for CRPS in the hope of longer-duration effect. Evidence for the add-on is thin - discuss before consent.
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Series of two or three blocks
A single block is a test dose. If it helps for one to four weeks, a short series at one to two week intervals is standard for CRPS, PTSD trials and vasomotor symptoms.
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Radiofrequency ablation of the stellate
For patients who respond well to repeated blocks but relapse each time, pulsed RF of the stellate ganglion is an option in specialist centres.
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Thoracic sympathectomy
A surgical alternative for CRPS or severe hyperhidrosis that has responded to blocks but needs a durable effect. VATS procedure with its own risks.
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Second-opinion review
A specialist review of prior blocks, symptom diary and imaging - sometimes the answer is a different pain pathway, not another SGB.
Our vetted London network
A small panel of pain consultants, we picked them.
Consultants in pain medicine and anaesthesia running regular SGB lists across King’s College Hospital Private Pain, London Pain Clinic at Guy’s, HCA The Wellington Pain Management, Cleveland Clinic London Pain, Imperial Private at Chelsea and Westminster, and Nightingale Hospital Chronic Pain.
Selection criteria
How we choose every consultant in our network.
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Consultants in pain medicine or anaesthesia running a regular ultrasound-guided stellate list
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Resuscitation cover, IV access and lipid emulsion on the door (local anaesthetic toxicity)
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Honest triage: PTSD and long COVID are quoted as investigational, not standard care
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Onward pathways to pulsed RF, sympathectomy or specialist pain MDT when a series does not hold
Safety and recovery
What to expect afterwards - honestly.
Expected side effects (droopy eyelid, hoarse voice, warm arm) are signs the block worked. Serious complications are rare with ultrasound-guided technique in a resuscitation-ready unit.
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Horner’s syndrome is expected
A droopy eyelid, small pupil, and dry warm face on the treated side means the block worked. It wears off with the local anaesthetic in a few hours.
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Hoarse voice from recurrent laryngeal block
Roughly one in three patients has a temporary hoarse voice for a few hours. Avoid solid food and hot drinks until the swallow feels normal.
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Ipsilateral diaphragm weakness
Phrenic nerve spread can weaken the diaphragm on the treated side. Usually silent, but people with severe COPD or a single lung must be flagged before consent.
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Vertebral artery injection - rare but serious
A misplaced injection into the vertebral artery can cause immediate seizure or loss of consciousness. Ultrasound guidance and careful aspiration make this very rare.
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Oesophageal or thyroid puncture
A right-sided approach carries a small risk of oesophageal or tracheal injury. Ultrasound-guided technique keeps this vanishingly low.
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Local anaesthetic systemic toxicity
Ringing in the ears, metallic taste or dizziness in the first few minutes must be reported at once. Units keep intralipid on the door for this reason.
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No driving for 24 hours
Sedation, an unequal pupil and a hoarse voice make driving unsafe. Arrange transport home and someone with you for the first evening.
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Bilateral blocks are avoided
Two stellate blocks in one sitting can cause bilateral recurrent laryngeal palsy and a stridulous airway - so the second side is left for another day.
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Red flags after discharge
A persistent hoarse voice beyond 24 hours, breathlessness, chest pain, severe headache or new limb weakness - call the unit or go to A&E the same day.
Reading your procedure note
Your SGB note in four parts. Read the last one first.
Whichever approach was used, the note the consultant sends you keeps to the same shape.
A quiet reminder
Pain-medicine language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication, side and approach
The reason for the block (CRPS, PTSD trial, hot flushes, angina), which side was treated, and whether an anterior paratracheal or fluoroscopy-guided approach was used.
- 02 Technique
Drug, volume and confirmation
Which local anaesthetic (usually bupivacaine 0.5%), the volume, whether steroid was added, and whether a Horner’s syndrome confirmed adequate sympathetic blockade.
- 03 Findings
Response and complications
Immediate pain score change, temperature rise in the treated hand, and any hoarseness, breathlessness or LAST symptoms during the 30 to 45 minute recovery.
- 04 Impression
Plan and follow-up
Read this first: whether a series is recommended, at what interval, when to review, and what an inadequate response would push the plan towards next.
Recognised by major UK insurers
Cover for SGB is common for CRPS and refractory angina. For PTSD, hot flushes and long COVID, most insurers class it as investigational and self-pay is the norm - we confirm before booking.
Frequently asked
Everything we get asked about SGB.
Quick answers on evidence, insurance, safety, hot flushes, a series of blocks and how quickly you will know.
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Does stellate ganglion block really help PTSD?
The evidence is mixed. The best RCTs show a small but real reduction in CAPS symptom scores at eight weeks, and the US military uses SGB widely for service personnel. In the UK, SGB for PTSD remains investigational, not a NICE-endorsed treatment. We only offer it after a candid conversation about the cost, the modest effect size, and the fact that trauma-focused CBT and EMDR remain first-line.
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Will my insurance cover SGB?
Cover is common for CRPS and for refractory angina where the indication is documented by a consultant. Cover is unusual for PTSD, menopausal hot flushes and long COVID because UK guidelines do not yet list SGB as standard care for these. We check pre-authorisation with your insurer before you book anything.
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How safe is a stellate ganglion block?
In experienced ultrasound-guided hands the serious complication rate is under 1%. The commonest side effects - a droopy eyelid, small pupil and hoarse voice - are expected signs the block worked and wear off in a few hours. Vertebral artery injection is the feared complication; ultrasound and careful aspiration make it very rare. Unit protocols include lipid emulsion on the door for local anaesthetic toxicity.
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Can SGB help with menopausal hot flushes?
Yes, modestly, and only worth considering for women who cannot take HRT (breast cancer survivors, high VTE risk, or personal preference against hormones). RCTs show a reduction in daytime hot flush frequency and severity for around one to three months. It is not a first-line option - non-hormonal medications and CBT are tried first.
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Do I need a series of blocks or just one?
A single block is the diagnostic test dose. If pain, hot flushes or PTSD symptoms clearly improve for one to four weeks, a series of two or three at one to two week intervals is standard. If the first block does nothing, we stop and rethink rather than repeat.
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How quickly will I know if it worked?
For pain, within minutes to hours - a warm hand, reduced skin sensitivity and a drop in pain score. For PTSD, hot flushes and long COVID the response can take a few days to declare itself, and we plan a review at two weeks before deciding on a series.
Ready when you are
An honest read on whether SGB is worth doing, from an independent team.
Send us your indication and any prior clinic letters. Within one working day we come back with a shortlist of two or three London consultants, a firm cost, and a candid opinion on the evidence tier for your case.
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