200 Section - Symptom Relief and Adipose Reduction via Stellate Ganglion Block: A Novel Dual-Action Therapeutic Approach in Postmenopausal Angina

Case Diagnosis: Refractory Postmenopausal Angina

Case Description: Ultrasound-guided stellate ganglion block (US-SGB) is a well-established therapy for sympathetically mediated pain and is increasingly being utilized for non-painful indications, including cardiovascular sympathetic modulation and menopausal vasomotor symptoms. Excess sympathetic drive contributes to the pathogenesis of obesity and metabolic dysfunction, and interventions that decrease sympathetic outflow can improve metabolic parameters. The sympathetic nervous system directly innervates white adipose tissue, where catecholamine signaling promotes lipolysis.
A 57-year-old female (BMI 33) with refractory postmenopausal angina underwent serial US-SGB at the right C6 and C4 levels, administered three times over a two-month period. Angina symptoms, vasomotor complaints, and body composition were monitored. Objective fat loss was assessed via serial anthropometric measurements and bioimpedance analysis.

Discussions: Following US-SGB, the patient experienced marked improvement in angina and vasomotor symptoms, consistent with prior reports of SGB efficacy in these domains. Serial measurements also showed significant reduction in body fat percentage and waist circumference, without changes in diet or physical activity. No adverse events were observed.

Conclusions: This case suggests that US-SGB can exert effects on metabolism beyond symptom control, potentially through sympathetic modulation within adipose tissue. Overall, US-SGB can be considered a therapeutic agent for refractory postmenopausal angina and menopausal symptoms in women, with initial evidence to support additional metabolic benefits. Literature already exists on the safety and efficacy of SGB, particularly for attenuating cardiovascular sympathetic activity and menopausal vasomotor symptoms in patients unresponsive to standard therapy. Mechanistically, sympathetic blockade may facilitate lipolysis and weight reduction. These actions and mechanisms should be validated in more rigorously controlled studies.