Stellate Ganglion Block for Headache Pain and Cognitive Impairment Associated With Long COVID Persisting Over 12 Months: A Case Report.

BACKGROUND: Postacute sequelae of COVID-19 (PASC) are debilitating health conditions affecting over 7% of the US population. Clinical PASC manifestations are variable, but consistently involve dysautonomia and elevated inflammatory biomarkers. Common symptoms include pain, fatigue, cognitive impairment, sensory loss, and orthostatic intolerance. As neuroimmune hyperactivation and reductions in cerebral blood flow are each implicated in PASC pathophysiology, stellate ganglion block (SGB) represents a promising treatment option due to its ability to reset autonomic activity and reperfuse the brain. We sought to retrospectively assess the potential of SGB to treat head and neck pain, cognitive impairment, and fatigue associated with PASC persisting over 12 months.

CASE REPORT: We reviewed and analyzed case data from 2 middle-aged female patients with painful, longstanding PASC managed with repeat unilateral SGB. Procedures were performed under ultrasound guidance, with 3 mL 0.5% bupivacaine + 12 mg betamethasone as the injectate. Each patient received 2 SGBs, with all procedures being tolerated well. No complications occurred. One patient had a recurrence of migraine pain following the blocks, while the other experienced durable relief. Both patients saw improvements in cognitive function and fatigue postoperatively, which were sustained.

CONCLUSIONS: Most literature on SGB for PASC management concerns its ability to reverse sensory loss, rather than relieve chronic pain. This case report provides preliminary evidence supporting the effectiveness of SGB for managing pain and cognitive impairment in PASC. As PASC symptoms with longer durations tend to be less effectively managed with SGB, we speculate that chronicity of the patients' symptoms hampered SGB-mediated pain relief.