Integrative Bilateral Cervical Sympathetic Blocks for Trauma-Related Symptoms in Special Operations Veterans: A Prospective Case Series

Inclusion Criteria:

* 18 years or older
* PTSD (PCL Score of 33 or greater at baseline screening)
* Willing and able to provide informed consent and complete study procedures
* Fluent in English
* Special Operations Forces Veteran

Exclusion Criteria:

* Recent Sympathetic Block: Receipt of any cervical sympathetic block (including stellate ganglion block \[SGB\], dual sympathetic ganglion block \[DSGB\], or bilateral SGB/BCSB), whether unilateral or bilateral, within the past 6 months.
* Concurrent interventional clinical trial participation: Currently enrolled in another interventional clinical trial or receiving any experimental treatment targeting PTSD, TBI, or autonomic dysfunction during the study period
* Acute Psychiatric Instability: Currently experiencing acute psychiatric crisis requiring inpatient care, active suicidal or homicidal intent, or untreated mania, psychosis, or severe dissociation
* Medical Contraindications to BCSB: Any known anatomical abnormalities, bleeding disorders, allergy to local anesthetics, pregnancy, or comorbidities that represent a contraindication to receiving a cervical sympathetic block, per the treating physician's judgment.
* Language or communication barriers: Inability to read, speak, or understand English sufficiently to complete informed consent and study assessments
* Low PTSD Symptom Severity at Baseline: PCL-5 Score \< 33 at screening, indicating subclinical or minimal PTSD symptoms (Rationale: to ensure measurable clinical benefit and reduce floor effects)