Effect of Preoperative Ultrasound-Guided Stellate Ganglion Block on Postoperative Delirium in Older Adults Undergoing Elective Peripheral Endovascular Intervention
Effect of Preoperative Ultrasound-Guided Stellate Ganglion Block on Postoperative Delirium in Older Adults Undergoing Elective Peripheral Endovascular Interventions: A Randomized Controlled Trial.
This randomized controlled trial will evaluate whether preoperative ultrasound-guided stellate ganglion block reduces the incidence of postoperative delirium in adults aged 60 years or older undergoing elective peripheral endovascular interventions. Participants will be randomly allocated in a 1:1 ratio to receive either a right-sided ultrasound-guided stellate ganglion block at the C6 level with 5 mL of 0.375% ropivacaine or a control group. Postoperative delirium will be assessed twice daily during the first 3 postoperative days using the 3-Minute Diagnostic Interview for Confusion Assessment Method-defined Delirium (3D-CAM).
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Descripción detallada
Postoperative delirium is a frequent complication among older adults undergoing surgery and vascular interventions. This study will investigate whether preoperative ultrasound-guided stellate ganglion block can reduce postoperative delirium through modulation of sympathetic activity and potentially inflammatory responses.
Eligible participants aged 60 years or older undergoing elective peripheral endovascular interventions will be randomly allocated in a 1:1 ratio to an active stellate ganglion block group or control group. The active intervention will consist of a right-sided ultrasound-guided stellate ganglion block performed at the C6 level approximately 30 minutes before surgery, using a 22-gauge needle and 5 mL of 0.375% ropivacaine. The control group will receive standard perioperative care and regional anesthesia according to the study protocol, but no stellate ganglion block or sham procedure will be performed
All participants will receive standardized anesthesia consisting of ultrasound-guided combined femoral and sciatic nerve blocks with bupivacaine, supplemented by dexmedetomidine sedation.
The primary outcome will be cumulative incidence of postoperative delirium from postoperative day 1 through postoperative day 3, assessed twice daily using the 3D-CAM. Secondary outcomes will include delirium severity, delirium duration, postoperative pain, opioid consumption, and safety/adverse events.
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: loay mohamed Gamal, master
- Número de teléfono: +201017675686
- Correo electrónico: loaygamal94@gmail.com
Copia de seguridad de contactos de estudio
- Nombre: mohamed mamdouh mohamed, MD
- Número de teléfono: +201011976368
- Correo electrónico: Mamdouh372@med.aun.edu.eg
Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Age ≥65 years.
- Scheduled for elective peripheral endovascular interventions.
- American Society of Anesthesiologists (ASA) physical status I-III.
- Ability to provide written informed consent or consent through a legal representative
Exclusion Criteria:
- Preexisting cognitive impairment (Montreal Cognitive Assessment score below the education-adjusted cutoff) or diagnosed dementia.
- Severe visual or hearing impairment or language barrier precluding reliable delirium assessment.
- Major psychiatric disorders, including schizophrenia or bipolar disorder.
- Contraindications to stellate ganglion block, including local infection at the puncture site, known allergy to local anesthetics, or severe coagulopathy.
- Severe systemic disease, including Child-Pugh C liver cirrhosis, end-stage renal disease (eGFR <30 mL/min/1.73 m² or dialysis), or NYHA class III-IV heart failure.
- Emergency surgery.
- History of substance abuse
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Prevención
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Doble
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
|---|---|
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Experimental: Ultrasound-Guided Stellate Ganglion Block
Participants will receive a right-sided ultrasound-guided stellate ganglion block at the C6 level approximately 30 minutes before surgery. Under sterile conditions and real-time ultrasound guidance, a 22-gauge needle will be advanced to the prevertebral fascia. After negative aspiration, 5 mL of 0.375% ropivacaine will be injected. Successful sympathetic blockade will be assessed by development of Horner's syndrome and/or a relative increase in ipsilateral skin temperature of ≥1.5°C within 15 minutes after injection |
5 mL of 0.375% ropivacaine administered during ultrasound-guided right stellate ganglion block at the C6 level approximately 30 minutes before surgery. |
|
Sin intervención: control group
the participants will receive standard perioperative care and regional anesthesia according to the study protocol, but no stellate ganglion block or sham procedure will be performed |
¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Cumulative incidence of postoperative delirium
Periodo de tiempo: postoperative 24 hours , 48 hours , 72 hours.
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.Postoperative delirium will be assessed twice daily during the first 3 postoperative days using the 3-Minute Diagnostic Interview for Confusion Assessment Method-defined Delirium (3D-CAM). A participant will be considered to have developed postoperative delirium if at least one postoperative delirium assessment is positive during the first 3 postoperative days. |
postoperative 24 hours , 48 hours , 72 hours.
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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Delirium severity
Periodo de tiempo: postoperative 24 hours , 48 hours , 72 hours , among participants diagnosed with postoperative delirium
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the severity of delirium will be graded using Memorial Delirium Assessment Scale (MDAS) |
postoperative 24 hours , 48 hours , 72 hours , among participants diagnosed with postoperative delirium
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Duration of postoperative delirium
Periodo de tiempo: postoperative 24 hours , 48 hours , 72 hours.
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Number of postoperative days with a positive 3D-CAM assessment |
postoperative 24 hours , 48 hours , 72 hours.
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Postoperative pain intensity
Periodo de tiempo: Immediate postoperative period 2 hours 6 hours 12 hours 24 hours
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Postoperative pain intensity will be assessed by Numerical Rating Scale (NRS) |
Immediate postoperative period 2 hours 6 hours 12 hours 24 hours
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Total postoperative opioid consumption
Periodo de tiempo: postoperative 24 hours , 48 hours , 72 hours.
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by Morphine milligram equivalents (MME) |
postoperative 24 hours , 48 hours , 72 hours.
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Safety and adverse events
Periodo de tiempo: postoperative 24 hours , 48 hours , 72 hours.
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postoperative 24 hours , 48 hours , 72 hours.
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Publicaciones y enlaces útiles
Publicaciones Generales
- Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014 Mar 8;383(9920):911-22. doi: 10.1016/S0140-6736(13)60688-1. Epub 2013 Aug 28.
- Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol. 2010 Jun;119(6):737-54. doi: 10.1007/s00401-010-0674-1. Epub 2010 Mar 24.
- Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009 Dec;103 Suppl 1(Suppl 1):i41-46. doi: 10.1093/bja/aep291.
- Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013 Dec;21(12):1190-222. doi: 10.1016/j.jagp.2013.09.005.
- Marcantonio ER. Delirium in Hospitalized Older Adults. N Engl J Med. 2017 Oct 12;377(15):1456-1466. doi: 10.1056/NEJMcp1605501.
- Stevens RA, Stotz A, Kao TC, Powar M, Burgess S, Kleinman B. The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand. Reg Anesth Pain Med. 1998 May-Jun;23(3):266-70. doi: 10.1016/s1098-7339(98)90053-0.
- Gao WB, Wang WH, Zhou ST, Lu ZW, Xiang X, Hu J, Jin TY, Ni CB, Yao M, Ni HD. Efficacy of Repetitive Transcranial Magnetic Stimulation on Postoperative Delirium in Elderly Patients Undergoing Non-Cardiac Major Surgery: A Randomized Controlled Trial. Brain Behav. 2026 Feb;16(2):e71242. doi: 10.1002/brb3.71242.
- Yoo Y, Lee CS, Kim YC, Moon JY, Finlayson RJ. A Randomized Comparison between 4, 6 and 8 mL of Local Anesthetic for Ultrasound-Guided Stellate Ganglion Block. J Clin Med. 2019 Aug 27;8(9):1314. doi: 10.3390/jcm8091314.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Manifestaciones neurológicas
- Enfermedades del Sistema Nervioso
- Enfermedades Vasculares
- Enfermedades cardiovasculares
- Desordenes mentales
- Complicaciones Postoperatorias
- Procesos Patológicos
- Confusión
- Manifestaciones neuroconductuales
- Trastornos neurocognitivos
- Aterosclerosis
- Arteriosclerosis
- Enfermedades arteriales oclusivas
- Enfermedades vasculares periféricas
- Delirio
- Condiciones Patológicas, Signos y Síntomas
- Signos y síntomas
- Delirio de emergencia
- Enfermedad arterial periférica
- Químicos orgánicos
- Aniluros
- Amidas
- Compuestos anilina
- Amina
- Ropivacaína
Otros números de identificación del estudio
Otros números de identificación del estudio
- Postoperative Delirium
Información sobre medicamentos y dispositivos, documentos del estudio
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