Effects of stellate ganglion block on early brain injury in patients with subarachnoid hemorrhage: a randomised control trial

Jian Zhang, Ying Nie, Qiongni Pang, Xubiao Zhang, Qianting Wang, Jing Tang, Jian Zhang, Ying Nie, Qiongni Pang, Xubiao Zhang, Qianting Wang, Jing Tang

Abstract

Background: Subarachnoid hemorrhage (SAH) is a common neurosurgical emergency, and early brain injury (EBI) plays an important role in acute brain injury of SAH. Our objective is to investigate the effect of stellate ganglion block (SGB) on the clinical prognosis of patients with SAH (registration number ChiCTR2000030910).

Methods: A randomized controlled trial was conducted with 102 participants. Patients with SAH were assigned to the SGB or nSGB group. Patients in the SGB group received SGB four times (once every other day starting on the day of the surgery). In contrast, patients in the nSGB group only received standard care. Data were collected on the day before surgery (T0) and on the 1st (T1), 3rd (T2) and 7th day (T3) after surgery. The primary outcomes included EBI markers (including IL-1β, IL-6, TNF-α, ET-1, NPY, NSE and S100β), the mean cerebral blood flow velocity of the middle cerebral artery (Vm-MCA) and the basilar artery (Vm-BA). All cases were followed up for 6 months after surgery.

Results: The levels of the EBI markers in both groups were higher at T1-T3 than at T0 (P<0.05), and the Vm-MCA and Vm-BA were also increased at the same times. However, the levels of the EBI markers were lower in the SGB group than in the nSGB group (P<0.05), and the increases of Vm-MCA and Vm-BA were also lower (P<0.05). The prognosis score and neurological deficit were better in the SGB group than in the nSGB group (P<0.05).

Conclusions: SGB can improve the prognosis of SAH patients by inhibiting the inflammatory response during EBI and by reducing endothelial dysfunction and relieving CVS.

Trial registration: Clinical trial number: ChiCTR2000030910 ; Registry URL: Chinese Clinical Trial Registry; Principal investigator's name: Ying Nie; Date of Trial registration: March, 2020 (retrospectively registered).

Keywords: Cervical sympathetic trunk; Early brain injury; Stellate ganglion block; Subarachnoid hemorrhage; Transcranial Doppler.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing the search process for included studies
Fig. 2
Fig. 2
Changes in the Blood Flow Velocity of MCA and BA in Different Time Periods. Comparison of the changes in the blood flow velocity of MCA (a) and BA (b) in the different time periods. Each bar represents the mean±S.E.M. *** P<0.001, ****P<0.0001
Fig. 3
Fig. 3
a-c Changes of Inflammatory Cytokines in EBI between the SGB Group and the nSGB Group. Comparison of the changes of inflammatory mediators such as Il-1β (a) Il-6 (b) and TNF-α (c) between the SGB Group and the nSGB Group. Each bar represents the mean±S.E.M. *P<0.05, **P<0.01*** P<0.001. d-e Changes of Vascular Physiological Markers in EBI between the SGB Group and the nSGB Group. Comparison of the changes of vascular physiological markers such as ET-1 (d) and NPY (e) between the SGB Group and the nSGB Group. Each bar represents the mean±S.E.M. *P<0.05, **P<0.01. f-g Changes of Brain Injury Markers in EBI between the SGB Group and the nSGB Group. Comparison of the changes of brain injury markers such as NSE (f) and S100β (g) between the SGB Group and the nSGB Group. Each bar represents the mean±S.E.M. *P<0.05, **P<0.01

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