Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 26 28 Ebrahim Espahbodi Tehran University of Medical Sciences Mahsa Raji Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Mahsa Raji Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Reza Rahmani Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Saghar Samimi Department of Anesthesiology, Critical Care and Pain Management, Tehran University of Medical Sciences, Tehran, Iran Mehrzad Rahmanian Department of cardiac surgery, Tehran University of Medical Sciences, Tehran, Iran Ali Karbasforoshan Department of Cardiology, Zanjan University of Medical Sciences, Zanjan, Iran Mehdi Sanatkar Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran 2025 11 25 2025 12 01 Abstract Background: Refractory angina remains a major therapeutic challenge when revascularization options are unavailable. Stellate ganglion block (SGB) may reduce sympathetic tone, improve coronary perfusion, and alleviate ischemic chest pain. This study evaluated the effects of SGB on the severity of chest pain and ST-segment deviation during exercise testing. Methods: This before–and–after interventional study included patients with confirmed coronary artery disease and refractory angina. Baseline treadmill testing assessed angina index and ST-segment deviation. SGB was performed under ultrasound guidance using 0.25% bupivacaine and dexamethasone. Treadmill testing was repeated 24–48 hours after the block. Results: Sixteen patients participated (56% male; mean age 60.7±9.7 years). The angina index significantly improved (1.90±0.34 to 0.50±0.32; P < 0.001). ST-segment deviation decreased modestly but significantly (1.0±0.4 to 0.9±0.3 mm; P=0.041). No major complications occurred. Conclusion: SGB significantly reduced chest pain severity and improved ischemic ST-segment abnormalities in patients with refractory angina. It may serve as a safe and effective adjunct therapy. https://aacc.tums.ac.ir/index.php/aacc/article/view/1502