Stellate Ganglion Block for Long COVID Symptoms: A Randomized Controlled Trial

Inclusion Criteria: * Adults aged 18 years and older * Positive COVID-19 test confirmed by RT-PCR, antibody test, or antigen test at least 3 months prior to randomization, OR presumed COVID-19 evaluated by the site investigator (no positive test required) with an acute illness occurring after October 15, 2019 and at least 3 months prior to randomization. * Persistent symptoms ≥12 weeks after onset of acute COVID-19 AND symptoms lasting at least 2 months. The onset date is defined as the earliest of: date of first positive test, date of first symptoms * Post-COVID Functional Status Scale score ≥2. * Persistent dyspnea ≥2/4 on the mMRC scale at least 12 weeks post-infection. * Persistent COVID-19-related symptoms at the time of randomization. * If taking medications for fatigue or cognition (e.g., sildenafil, modafinil, armodafinil, guanfacine, N-acetylcysteine, stimulants for ADHD), these must have been initiated and stable for ≥4 weeks prior to randomization. Participants are asked not to stop or alter these medications during the study if possible. * Able and willing to provide written informed consent. * Able to read and understand French. Exclusion Criteria: * Prior diagnosis of myalgic encephalomyelitis (ME) or fibromyalgia * Being on sick leave or disability at the time of the original acute COVID-19 infection. * Pregnancy or breastfeeding. * Myocardial infarction within the last 12 weeks. * Use of anticoagulant therapy. * Glaucoma. * Emphysema requiring home oxygen. * Cardiac conduction abnormalities. * Known hypersensitivity to bupivacaine. * Previous stellate ganglion block (SGB) procedure. * Any condition that, in the judgment of the medical investigator, makes the patient not a candidate for the proposed treatment.