Stellate Ganglion Block for Post-acute Sequelae of SARS-CoV-2 Infection With Coexisting Post-traumatic Stress...

Post-acute sequelae of SARS-CoV-2 infection (PASC), commonly referred to as long COVID, is characterized by persistent symptoms, including fatigue, cognitive dysfunction, pain, and neuropsychiatric complaints, that can impair daily functioning. Proposed mechanisms are heterogeneous and may include autonomic dysregulation in a subset of patients. Stellate ganglion block (SGB) is a cervical sympathetic block used to treat symptoms of post-traumatic stress disorder (PTSD), anxiety, and, more recently, PASC. A 58-year-old man with a history of attention-deficit/hyperactivity disorder, generalized anxiety disorder, obsessive-compulsive disorder, autism spectrum disorder, PTSD, and chronic musculoskeletal pain developed persistent post-COVID symptoms following infection in March 2020, including brain fog, slowed information processing, word-finding difficulty, worsening anxiety, impaired balance, and reduced hand-eye coordination that significantly impaired occupational functioning as a chef. In January 2023, sequential left- and right-sided SGBs one week apart were performed to address cognitive dysfunction, fatigue, pain, and anxiety. Follow-up documentation described marked improvement in anxiety, frustration tolerance, and cognition lasting approximately six months. Repeat right-sided SGBs were performed in December 2024 and September 2025 for recurrence of symptoms and were again associated with symptomatic improvement. This is the first case demonstrating both longitudinal and reproducible functional improvement in cognitive symptoms, anxiety, and pain following serial SGBs in a patient with PASC complicated by psychiatric comorbidity and chronic pain. Although emerging observational literature suggests potential benefit of SGB in selected patients with PASC, prospective controlled studies are required to determine efficacy, mechanisms, and long-term outcomes.