BLOCK-SAH - PPF-Block for Post-SAH Headache (BLOCK-SAH)

November 25, 2025 updated by: University of Florida

Pterygopalatine Fossa (PPF) Block as an Opioid Sparing Treatment for Acute Headache in Spontaneous Subarachnoid Hemorrhage

BLOCK-SAH is a phase II, multicenter, randomized, double-blinded, placebo-controlled clinical trial with a sequential parallel comparison design (SPCD) of bilateral pterygopalatine fossa (PPF) injections with 20mg ropivacaine + 4mg dexamethasone (active, PPF-block) compared to saline (placebo) for headache in survivors of aneurysmal subarachnoid hemorrhage (SAH), while monitoring intracranial arterial mean flow velocities with transcranial Doppler (TCD) peri-intervention (intervention = PPF-injections: active or placebo)

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

195

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • Florida
      • Gainesville, Florida, United States, 32610
    • Georgia
      • Atlanta, Georgia, United States, 30322
        • Recruiting
        • Emory University
        • Contact:
        • Principal Investigator:
          • Ofer Sadan, MD
    • Maryland
      • Baltimore, Maryland, United States, 21201
        • Recruiting
        • University of Maryland Baltimore
        • Contact:
        • Principal Investigator:
          • Nicholas Morris, MD
    • Minnesota
      • Rochester, Minnesota, United States, 55009
        • Recruiting
        • Mayo Clinic
        • Contact:
        • Principal Investigator:
          • Narayan Kissoon, MD
    • New York
      • Albany, New York, United States, 12208
        • Recruiting
        • Albany Medical College
        • Contact:
        • Principal Investigator:
          • Charles Argoff, MD
      • Rochester, New York, United States, 14642
        • Recruiting
        • University of Rochester Medical College
        • Contact:
        • Principal Investigator:
          • Matthew Bender, MD
    • Ohio
      • Cincinnati, Ohio, United States, 45267
        • Recruiting
        • University of Cincinnati
        • Principal Investigator:
          • Charles Prestigiacomo, MD
        • Contact:
    • Oregon
      • Portland, Oregon, United States, 97239
        • Recruiting
        • Oregon Health and Sciences University
        • Contact:
        • Principal Investigator:
          • Ines Koerner, MD
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19107
        • Not yet recruiting
        • Thomas Jefferson University
        • Principal Investigator:
          • Stavropoula Tjoumakaris, MD
        • Contact:
    • Washington
      • Seattle, Washington, United States, 98104
        • Recruiting
        • University of Washington
        • Contact:
        • Principal Investigator:
          • Sarah Wahlster, MD
    • Wisconsin
      • Milwaukee, Wisconsin, United States, 53226
        • Recruiting
        • Medical College of Wisconsin
        • Contact:
        • Principal Investigator:
          • Tom Aufderheide, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

In order to be eligible to participate in this study, an individual must meet all of the following criteria:

  1. Provision of signed and dated ICF by participant or a legally authorized representative (LAR)
  2. Stated willingness to comply with all study procedures and availability for the duration of the study
  3. Male or female, aged ≥18 and ≤ 85 years
  4. Admitted with a primary diagnosis of spontaneous, non-traumatic, SAH within 72 hours of ictus hemorrhage

  5. Disease-specific inclusion criteria:

    1. Spontaneous, non-traumatic SAH
    2. Subarachnoid pattern of hemorrhage warranting diagnostic DSA due to involvement of at least one of the following regions: quadrigeminal plate, prepontine cistern, perimesencephalic cistern, Sylvian fissure, or surrounding Circle of Willis
    3. Modified Fisher grade 1-4 (on presentation imaging)
    4. Hunt and Hess 1-3 or World Federation of Neurosurgeons grade 1-4 (on screening, included only if also fulfilling Glasgow Coma Scale verbal subscore ≥4)
    5. Minimum Glasgow Coma Scale verbal subscore of 4 (on screening)

  6. Able to verbalize pain scale scores according to 11-point numeric pain scale

    In order to be enrolled and undergo randomization in this study, an individual must meet all of the additional criteria:

  7. Stabilization period criteria:

    1. A minimum of 4 hours from DSA with clipping or coiling procedure (whenever applicable)
    2. Successful treatment of culprit vascular lesion (i.e., ≥90% obliteration of aneurysm), when applicable
  8. Requiring a minimum of 15mg OME prn for headache analgesia during any 24-hour period during eligibility period

Exclusion Criteria:

An individual who meets any of the following criteria will be excluded from participation in this study:

  1. Premorbid conditions:

    1. Pre-existing neurologic, psychiatric, or other condition that would confound neurologic assessment or would make difficult/impossible to accurately assess neurologic and/or functional outcome
    2. Pre-existing diffuse flow-limiting narrowing of arteries in the Circle of Willis, regardless of etiology (e.g., atherosclerosis, vasculitis, Moya-Moya syndrome)
    3. Prior use of opioid or barbiturate analgesics for at least two-thirds of the days in previous month, regardless of indication
    4. Diagnosis of substance use disorder in the previous year
    5. Infected or wounded skin, or a skin lesion at the site of puncture for PPF- injection

  2. Uncorrected coagulopathy

    1. Platelet count < 50,000/μL, International Normalized Ratio (INR) > 1.7
    2. Requiring use of systemic anticoagulation and antiplatelet therapy (except for aspirin monotherapy).

  3. SAH-specific:

    1. Head trauma as etiology of SAH
    2. Infection as cause for aneurysm or SAH (i.e., mycotic aneurysms)
    3. Inability to successfully treat culprit vascular lesion
    4. Diffuse vasospasm on pre-enrollment diagnostic CTA or DSA. Vasospasm is defined as moderate-to-severe arterial narrowing on DSA or CTA not attributable to atherosclerosis, catheter-induced spasm, or vessel hypoplasia, as determined by a neuroradiologist or neurointerventionalist

  4. Standard pain regimen conditions

    1. Elevation of hepatic enzymes prohibiting use of scheduled APAP (i.e., AST or ALT > 3x upper limit level)
    2. Chronic liver condition with absolute contra-indication for APAP (even at lower maximum daily doses)
  5. Participation in a concurrent investigational/interventional study (observational studies allowed)
  6. Known to be pregnant, or with a positive pregnancy test
  7. Allergy or intolerance to the medications used in the PPF-block (i.e., ropivacaine, dexamethasone) or standard pain regimen (APAP)
  8. Vulnerable populations such as prisoners and inmates (abiding GCP per the study IRB)
  9. Unable to receive first PPF-injection within 96 hours of ictus hemorrhage

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Sequential Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Group 1 - Active - Active
Subjects randomized to Group 1 will receive an active PPF nerve block in Stage 1 followed by an active PPF nerve block in Stage 2 of the Double-Blinded Trial Phase
Drug: Pterygopalatine Fossa Nerve Block with Ropivacaine and Dexamethasone
Each PPF-active nerve block will consist of 20mg (4ml) ropivacaine plus 4mg (1ml) dexamethasone
Other Names:
  • Pterygopalatine Fossa Nerve Block
Other: Group 2 - Placebo - Active
Subjects randomized to Group 2 will receive a placebo PPF-injection in Stage 1 followed by an active PPF nerve block in Stage 2 of the Double-Blinded Trial Phase
Drug: Pterygopalatine Fossa Nerve Block with Ropivacaine and Dexamethasone
Each PPF-active nerve block will consist of 20mg (4ml) ropivacaine plus 4mg (1ml) dexamethasone
Other Names:
  • Pterygopalatine Fossa Nerve Block
Procedure: Placebo Pteryogpalatine Fossa Injection
Each placebo PPF-injection will consist of 5ml normal saline
Placebo Comparator: Group 3 - Placebo - Placebo
Subjects randomized to Group 3 will receive a placebo PPF-injection in Stage 1 followed by a placebo PPF-injection in Stage 2 of the Double-Blinded Trial Phase
Procedure: Placebo Pteryogpalatine Fossa Injection
Each placebo PPF-injection will consist of 5ml normal saline

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Primary Efficacy Endpoint
Time Frame: within 24 hours after each PPF-injection spanning the 48 hours of double-blinded treatment period
prn oral morphine equivalent (OME)/day use
within 24 hours after each PPF-injection spanning the 48 hours of double-blinded treatment period
Primary Safety Endpoint
Time Frame: at 48 hours from first PPF-injection (end of double-blinded treatment period)
incidence of radiographic vasospasm
at 48 hours from first PPF-injection (end of double-blinded treatment period)
Primary Tolerability Endpoint
Time Frame: at 24 hours following the first PPF-injection
rate of acceptance of second PPF-injection
at 24 hours following the first PPF-injection

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Florida

Collaborators

Massachusetts General Hospital
New York University
National Institute of Neurological Disorders and Stroke (NINDS)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 17, 2023

Primary Completion (Estimated)

January 15, 2027

Study Completion (Estimated)

February 28, 2027

Study Registration Dates

First Submitted

August 18, 2023

First Submitted That Met QC Criteria

August 18, 2023

First Posted (Actual)

August 24, 2023

Study Record Updates

Last Update Posted (Actual)

November 28, 2025

Last Update Submitted That Met QC Criteria

November 25, 2025

Last Verified

May 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB CED000000829
  • 1U01NS124613-01A1 (U.S. NIH Grant/Contract)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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