TL;DR
- What it is: An ultrasound-guided, perineural injection near the cervical vagus nerve (or a branch such as the superior laryngeal nerve) to modulate autonomic tone and neuro-inflammatory signaling. Think of it as a precise, image-guided nerve treatment — not surgery, not an implant.
- Why the vagus matters: The vagus nerve orchestrates the “cholinergic anti-inflammatory pathway” (CAP) — a brain–immune reflex that dials down cytokines via acetylcholine signaling. Clinical VNS studies show reduced inflammatory activity in rheumatoid arthritis, supporting the concept that vagal modulation can change inflammation biology.
- Where injections help today: Strongest real-world data exists for superior laryngeal nerve (SLN) blocks (a vagus branch) in neurogenic chronic cough, and ultrasound-guided perivagal blocks have been used for intractable hiccups. Evidence is promising but still early; large controlled trials are needed.
- Eterna’s edge: We deliver ultrasound-guided precision with medical-grade protocols and frequently stack autonomic work with Muse-cell–derived exosomes, MuseCells™, and peptides — our “signals + builders” model grounded in lab data showing higher trophic, anti-fibrotic and immunomodulatory profiles for MUSE vs hypoxic MSCs.
What Is a “Vagus Nerve Injection”? (Plain-English First, Science Second)
Plain-English: It’s a guided shot around the vagus nerve in the neck — or around a branch such as the superior laryngeal nerve (SLN) — to calm overactive nerve signaling and settle inflammation-related symptoms. We use ultrasound to visualize the carotid sheath (which contains the vagus nerve, carotid artery and internal jugular vein) and place a small volume of medication around the target safely.
Science: The vagus nerve is a core component of the CAP, a reflex arc that suppresses pro-inflammatory cytokines through α7-nicotinic signaling in immune cells. Clinical trials of vagus nerve stimulation (VNS) show reductions in TNF-α and improvements in inflammatory disease activity — evidence that changing vagal tone can alter immune set-points. Injections/blocks are a local, perineural way to modulate the same circuit (distinct from implanted stimulators).
Who Might Consider It?
- Chronic/neurogenic cough (often SLN block; SLN is a vagus branch): multiple retrospective series suggest symptom relief and improved cough scores, with low reported complication rates.
- Intractable hiccups: case reports document ultrasound-guided perivagal blocks and VNS use when medications fail.
- Autonomic dysregulation and inflammatory tone: while implanted or non-invasive VNS has the stronger evidence base, image-guided perineural approaches are being explored by pain/anesthesia teams for selected patients; the literature to date is case-level and requires shared decision-making.
Straight talk: For cough and hiccups the injection literature is most concrete (especially SLN block for cough). For broader inflammatory/“reset” aims, stronger randomized trials are still in progress in the stimulation (not injection) space — so we position injections as adjuncts inside a medical plan, not as a standalone cure.
How We Do It at Eterna (Single-Session Flow)
- Consult & screen: History, meds, airway/voice assessment; review goals (e.g., cough burden, hiccup frequency, dysautonomia symptoms).
- Ultrasound mapping: Identify carotid sheath structures and/or SLN trajectory; choose approach (perivagal vs SLN).
- Perineural injection: Small-volume local anesthetic ± adjunct (per protocol) under real-time ultrasound. Continuous monitoring and aspiration/needle control reduce vascular risk.
- Observation & plan: Brief post-procedure monitoring; home care; schedule for series if indicated (SLN blocks often require repeat sessions).
Why Eterna Often Stacks Autonomic Work with Muse & Exosomes
Rationale: Vagal modulation can de-escalate inflammatory tone, and MUSE-derived biologics provide trophic/anti-fibrotic support while immunomodulating T-cell activity — complementary levers for tissues under chronic inflammatory stress.
Your PDFs at a glance:
- Higher pluripotency & trophic factors (VEGF, HGF) and anti-fibrosis (MMP-2) in MUSE vs hypoxic MSCs (qPCR).
- Stronger T-cell suppression with MUSE in mixed lymphocyte assays (flow cytometry).
- Safety/efficacy positioning and homing via S1P/S1PR2 summarized in your one-pager.
Translation: We often pair vagus injections (for neural/autonomic tone) with Muse-exosomes or MuseCells™ (for pro-repair signals) and peptides (for metabolic and recovery support) in carefully sequenced protocols.
What the Evidence Says (2020–2025 Snapshot)
- Vagal anti-inflammatory biology: CAP reviews consolidate human data on vagus–immune crosstalk, identifying α7-nAChR as a key effector and mapping clinical directions.
- Clinical improvement with stimulation (context):
- Rheumatoid arthritis: both implanted and non-invasive VNS studies report reduced disease activity and TNF; these do not involve injection but validate the target (vagus).
- Injection/nerve-block literature (head & neck):
- SLN block for neurogenic chronic cough: 2020–2025 ENT/laryngology series show symptom improvements with steroid + lidocaine; repeat injections often help initial non-responders; safety profile is favorable but RCTs are still needed.
- Perivagal block for intractable hiccups: case experiences document ultrasound-guided cervical vagus blocks (e.g., 3.5 mL 0.25% bupivacaine) with benefit; other cases use implanted VNS when injections/meds fail.
- Ultrasound guidance improves precision and safety across head/neck blocks; most data are case series/observational — an evolving field.
Safety, Side-Effects & Who Should Avoid It
- Potential, generally uncommon effects (neck nerve blocks): hoarseness/voice change (recurrent laryngeal nerve proximity), dysphagia, local hematoma, transient Horner’s if sympathetic chain is spread to, and local anesthetic systemic toxicity (LAST) if intravascular dosing occurs — hence ultrasound, aspiration, dose discipline and monitoring.
- Cardiovascular considerations: the vagus participates in heart-rate control; continuous monitoring is standard during head/neck blocks.
- Absolute/relative cautions: active infection at site, bleeding risk/anticoagulation without plan, unstable airway/voice pathologies (for SLN), severe cardiac arrhythmias without clearance, pregnancy where risk–benefit is unclear.
What Results to Expect
- SLN (cough): many patients notice reduced cough frequency and less urge-to-cough after one or several sessions; maintenance varies.
- Perivagal (hiccups): case-level success exists; durable control sometimes requires adjuncts (meds, behavioral strategies) or VNS referral.
- Broader autonomic complaints: we set measurable goals (sleep, HRV markers, symptom scales) and combine with Muse-exosomes/peptides when appropriate; expectations are calibrated to the state of evidence.
FAQs
Is this the same as vagus nerve stimulation (VNS)?
No. Injections/blocks are perineural, short-acting procedures. VNS is electrical stimulation (implant or ear/neck devices). We use injections when anatomy or symptom targets (e.g., SLN for cough) make it practical, and we refer for VNS when evidence favors stimulation.
Will I be sedated?
Typically no. We need you awake for feedback and safety; local anesthesia and gentle technique plus ultrasound make it quick.
How many sessions will I need?
Cough (SLN): often 2–4 sessions spaced weeks apart, then reassess. Perivagal for hiccups: usually single trial with follow-up plan.
Can this be combined with exosomes or MuseCells™?
Yes — this is part of our stacked approach. Vagus modulation addresses neural/inflammatory tone; Muse-derived biologics add trophic and immunomodulatory support; peptides fine-tune recovery/metabolic pathways.
Sources & Further Reading — direct links shown
Anatomy, Guidance & Technique
- Carotid sheath contains vagus nerve (anatomy reference, BJA Education)
- Ultrasound-guided head/neck nerve blocks (narrative review)
- Ultrasound monitoring/precautions for cervical blocks
- Ultrasound imaging of cervical vagus for VNS surgery (anatomical localization)
Injection Evidence (Branches/Targeted Use-Cases)
- SLN block for neurogenic chronic cough (systematic/retrospective studies):
- Perivagal block for intractable hiccups (case experience with ultrasound guidance and bupivacaine)
Vagal Anti-Inflammatory Reflex (Context)
VNS Trials for Rheumatoid Arthritis (Target Validation)
- Non-invasive VNS in rheumatoid arthritis (Lancet Rheumatology, 2020)
- Implanted VNS in rheumatoid arthritis (Nature Reviews Rheumatology highlight, 2016)
Sympathetic Chain & Nearby Structures (Risk Context)
Eterna’s MUSE Stack (Internal References)
- Hypoxic MSCs vs Muse comparison (growth kinetics, pluripotency/trophic/anti-fibrotic, immunomodulation; figures & qPCR).
- Eterna one-page comparison (safety/pluripotency/anti-fibrosis/homing summary).