Three-Month Durability of Bilateral Two-Level Stellate Ganglion Blocks for Traumatic Brain Injury: A Retrospective Analysis

Background/Objectives: The primary aim of the study was to determine if ultrasound-guided, bilateral, two-level stellate ganglion blocks (SGBs), also known as two-level cervical sympathetic chain blocks (2LCSBs), performed on subsequent days, improve symptoms of chronic mild Traumatic Brain Injury (TBI) over a three-month period, as assessed by the Neurobehavioral Symptom Inventory (NSI). A secondary objective was to evaluate sex-based differences in outcomes during the same time period. Methods: A retrospective chart review was conducted between January 2024 and February 2025. We identified 41 patients who received bilateral 2LCSB for chronic (at least 3 months) TBI-related neurobehavioral symptoms as determined by NSI scores. NSI scores were collected at baseline, one week, one month, two months, and three months post treatment in 28 males and 13 females. An analysis of NSI scores and NSI-composite sub-scores was conducted to determine sex-based differences and 3-month differences in outcomes for patients receiving bilateral 2LCSB. Results: Of the 41 patients that underwent the bilateral 2LCSB procedure, 35 showed improvement in their NSI scores (85.36%) and 36 reported improvements in NSI sub-scores (87.8%). Across the entire dataset, patients experienced a 48.44% average decrease in total NSI scores from baseline and an average decrease of 43.11% in NSI sub-scores from baseline, indicative of improvements in TBI-specific symptoms. No statistical difference in outcomes was observed between males and females. Conclusions: Bilateral 2LCSB may provide rapid and durable TBI symptom improvement for 3 months, based on NSI scoring. However, additional research is necessary to establish causality.