Stellate Ganglion Block and Prognosis of Neurological Function After Subarachnoid Hemorrhage

N/ANot Yet RecruitingNCT07652749

Beijing Tiantan Hospital560 enrolled

Overview

The incidence of cerebral vasospasm after aneurysm subarachnoid hemorrhage (aSAH) is as high as 70%; cerebral vasospasm（CVS） is closely related to delayed cerebral ischemia （DCI）, which is one of the important reasons for poor outcomes in patients with aSAH. In recent years, it has been reported that stellate ganglion block(SGB) can effectively alleviate cerebral vasospasm(CVS), reduce cerebral blood flow velocity and increase cerebral perfusion in patients with aneurysm subarachnoid hemorrhage(aSAH)。However, whether the alleviation of CVS after SGB is beneficial to the long-term neurological prognosis has not been confirmed Therefore, a prospective randomized controlled study is needed to further explore the role of SGB block in improving the outcomes of patients with aSAH.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

560

Conditions

Aneurysmal Subarachnoid Hemorrhage Stellate Ganglion Block Neurological Prognosis

Interventions

Intervention groupPROCEDURE

Prior to the initiation of surgery, a single ultrasound-guided stellate ganglion block was performed on the ipsilateral side of the lesion.The dose and concentration of local anesthesia: 0.5% ropivacaine 5-10ml. Criteria for successful block: the patient developed Horner's syndrome, characterized by miosis, ptosis, eyeball caved in, nasal congestion, conjunctival congestion, reddish face and no sweat on the face

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age range: 18-65 years old; * Within 72 hours after onset of aSAH,and planning surgical treatment(aneurysm embolizing or clipping); * Preoperative Hunt-Hess grade 2-3 * Sign informed consent. Exclusion Criteria: * ASA \> grade IV; * Patients with posterior circulation aneurysm; * Patients with severe systemic hemorrhagic diseases; * Patients with trauma and local infection in the nerve block area; * Local anatomic structure changes (neck structure changes caused by radiotherapy, chemotherapy and surgery); * Allergy to known local anesthetics; * Pregnant and lactating women.

Outcomes

Primary Outcomes

The modified Rankin Scale (mRS) scores at 90 days

The modified Rankin Scale (mRS) is used to evaluate the primary outcome. The scale of mRS is 0 to 6. The best neurological outcome is the mRS with 0, indicating no any symptom left. mRS of 6 is the worst, indicating death. mRS will be evaluated by outcomes assessor who is blinded to the grouping.

Time frame: 90 days postoperatively

Secondary Outcomes

The incidence of delayed cerebral ischemia (DCI) during hospitalization

Time frame: At discharge, an average of 2 weeks

All cause mortality during 90 days after onset

Time frame: 90 days postoperatively

Length of stay in the intensive care unit and hosipital

Time frame: At discharge, an average of two weeks

Adverse events during hospitalization

Myocardial infarction, cardiac arrest, pulmonary embolism, infection, SGB related complications, etc