PMID- 37119094
OWN - NLM
STAT- MEDLINE
DCOM- 20231103
LR  - 20231107
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 139
IP  - 5
DP  - 2023 Nov 1
TI  - Early stellate ganglion block for improvement of postoperative cerebral blood 
      flow velocity after aneurysmal subarachnoid hemorrhage: results of a pilot 
      randomized controlled trial.
PG  - 1339-1347
LID - 10.3171/2023.3.JNS222567 [doi]
AB  - OBJECTIVE: Stellate ganglion block (SGB) is a commonly used sympathetic nerve 
      block technique that may have benefits for patients with aneurysmal subarachnoid 
      hemorrhage (aSAH) in the early stage. Cerebral vasospasm (CVS), one of the most 
      common complications of aSAH, is accompanied by an abnormal increase in cerebral 
      blood flow velocity (CBFV) and neurological dysfunction. In this pilot study the 
      authors sought to determine the feasibility of early SGB for CVS in aSAH patients 
      by observing the incidence of symptomatic CVS. METHODS: Prior to receiving 
      surgical treatment, patients with aSAH were randomly assigned to the SGB group or 
      the non-SGB group. The primary outcome was the incidence of symptomatic CVS 
      within 14 +/- 2 days after the onset of aSAH. As a higher CBFV is often associated 
      with CVS and a poor prognosis, the mean CBFV of the middle cerebral artery was 
      observed immediately after surgery and on postoperative days 1, 2, 3, 5, and 7. 
      Other secondary outcomes included transcranial Doppler (TCD)/CTA-type CVS, 
      delayed cerebral ischemia during hospitalization, new cerebral infarction within 
      3 months, adverse events (AEs), and clinical prognosis. RESULTS: Symptomatic CVS 
      occurred in 40% of patients in the non-SGB group and in 20% in the SGB group (RR 
      0.50, 95% CI 0.22-1.16). Continuous TCD sonography revealed that the 
      postoperative mean CBFV was lower in the SGB group than in the non-SGB group (F = 
      3.608, p = 0.02). In addition, the percentages of patients with CVS evaluated by 
      TCD (TCD-CVS) and total new infarctions within 3 months were also significantly 
      lower than those in patients with CVS (TCD-CVS 36.7% vs 70%, RR 0.52, 95% CI 
      0.31-0.89, and total new infarctions 26.7% vs 53.3%, RR 0.50, 95% CI 0.25-0.99). 
      In terms of AEs and mortality, there were no significant differences between the 
      two groups. CONCLUSIONS: This pilot study demonstrated for the first time, to the 
      authors' knowledge, that early SGB is feasible and has the potential to reduce 
      the risk of CVS and improve the prognosis of aSAH. This method may be a new 
      treatment for patients with aSAH that may have more advantages than traditional 
      therapeutic drugs and is worth further study. Clinical trial registration no.: 
      NCT04691271 (ClinicalTrials.gov).
FAU - Wu, Youxuan
AU  - Wu Y
AD  - Departments of1Anesthesiology and.
FAU - Lin, Fa
AU  - Lin F
AD  - 2Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; 
      and.
FAU - Bai, Yang
AU  - Bai Y
AD  - Departments of1Anesthesiology and.
FAU - Liang, Fa
AU  - Liang F
AD  - Departments of1Anesthesiology and.
FAU - Wang, Xinyan
AU  - Wang X
AD  - Departments of1Anesthesiology and.
FAU - Wang, Bo
AU  - Wang B
AD  - Departments of1Anesthesiology and.
FAU - Jian, Minyu
AU  - Jian M
AD  - Departments of1Anesthesiology and.
FAU - Wang, Yunzhen
AU  - Wang Y
AD  - Departments of1Anesthesiology and.
FAU - Liu, Haiyang
AU  - Liu H
AD  - Departments of1Anesthesiology and.
FAU - Wang, Anxin
AU  - Wang A
AD  - 3Department of Statistics, China National Clinical Research Center for 
      Neurological Diseases, Beijing, China.
FAU - Chen, Xiaolin
AU  - Chen X
AD  - 2Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; 
      and.
FAU - Han, Ruquan
AU  - Han R
AD  - Departments of1Anesthesiology and.
LA  - eng
SI  - ClinicalTrials.gov/NCT04691271
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20230428
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Humans
MH  - *Subarachnoid Hemorrhage/diagnostic imaging/surgery
MH  - Pilot Projects
MH  - Stellate Ganglion
MH  - Cerebral Infarction/etiology
MH  - *Autonomic Nerve Block/adverse effects
MH  - Cerebrovascular Circulation
MH  - *Vasospasm, Intracranial/etiology/epidemiology
OTO - NOTNLM
OT  - aneurysmal subarachnoid hemorrhage
OT  - cerebral blood flow velocity
OT  - cerebral vasospasm
OT  - stellate ganglion block
OT  - surgical technique
OT  - vascular disorders
EDAT- 2023/04/29 19:43
MHDA- 2023/11/03 06:44
CRDT- 2023/04/29 07:23
PHST- 2022/11/13 00:00 [received]
PHST- 2023/03/01 00:00 [accepted]
PHST- 2023/11/03 06:44 [medline]
PHST- 2023/04/29 19:43 [pubmed]
PHST- 2023/04/29 07:23 [entrez]
AID - 10.3171/2023.3.JNS222567 [doi]
PST - epublish
SO  - J Neurosurg. 2023 Apr 28;139(5):1339-1347. doi: 10.3171/2023.3.JNS222567. Print 
      2023 Nov 1.