Academic Journal
Effect of stellate ganglion block on brain hemodynamics and the inflammatory response in moderate and severe traumatic brain injury: a pilot study.
| Τίτλος: | Effect of stellate ganglion block on brain hemodynamics and the inflammatory response in moderate and severe traumatic brain injury: a pilot study. |
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| Συγγραφείς: | Kostadinov I; University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia ivan.kostadinov@kclj.si primoz.gradisek@kclj.si.; Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia., Avsenik J; University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.; Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia., Osredkar J; Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.; University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia., Jerin A; Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.; University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia., Gradisek P; University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia ivan.kostadinov@kclj.si primoz.gradisek@kclj.si.; Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia. |
| Πηγή: | Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2026 Jun 05; Vol. 51 (6), pp. 687-694. Date of Electronic Publication: 2026 Jun 05. |
| Τύπος έκδοσης: | Journal Article; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BMJ Country of Publication: England NLM ID: 9804508 Publication Model: Electronic Cited Medium: Internet ISSN: 1532-8651 (Electronic) Linking ISSN: 10987339 NLM ISO Abbreviation: Reg Anesth Pain Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2018- : [London, United Kingdom] : BMJ Original Publication: Secaucus, NJ : Churchill Livingstone, c1998- |
| Ιατρικοί όροι (MeSH): | Autonomic Nerve Block*/methods , Brain Injuries, Traumatic*/physiopathology , Brain Injuries, Traumatic*/diagnostic imaging , Brain Injuries, Traumatic*/therapy , Cerebrovascular Circulation*/drug effects , Cerebrovascular Circulation*/physiology , Hemodynamics*/drug effects , Hemodynamics*/physiology , Stellate Ganglion*/drug effects , Stellate Ganglion*/diagnostic imaging , Stellate Ganglion*/physiology , Inflammation Mediators*, Anesthetics, Local/administration & dosage ; Levobupivacaine/administration & dosage ; Adult ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Severity of Illness Index ; Treatment Outcome |
| Περίληψη: | Introduction: Traumatic brain injury (TBI) is often associated with reduced cerebral blood flow and an increased inflammatory response, leading to secondary brain damage. Stellate ganglion block (SGB) has been shown to improve cerebral hemodynamics in non-TBI, but its effects in TBI are still unclear. Objective: This prospective pilot study investigates the effects of SGB on cerebral hemodynamics and neuroinflammatory responses in patients with moderate to severe TBI with the aim of evaluating its potential as a therapeutic intervention. Methods: A prospective, single-center observational study was conducted in 20 patients with moderate to severe TBI. SGB was performed ipsilateral to the most severely affected hemisphere using an ultrasound-guided lateral approach at the level of C6 with 8 mL 0.5% levobupivacaine. The primary outcome was the change in blood flow velocity in the ipsilateral middle cerebral artery as measured by transcranial color-coded duplex ultrasonography before and after the procedure. Secondary outcomes included changes in (a) the diameter of the basal arteries of the brain as measured by computed angiography tomography; (b) cerebral blood flow, volume and time to peak as measured by computed perfusion tomography; (c) cerebral perfusion pressure, intracranial pressure and brain oxygenation. The changes in the biomarkers of inflammation and brain injury interleukin 6, neuron-specific enolase, protein S100B and glial fibrillar acidic protein measured at baseline, 12 hours and 24 hours after SGB were defined as tertiary outcomes. Results: SGB significantly reduced blood flow velocity in the middle cerebral artery, increased the diameter of the large basal cerebral arteries, improved cerebral blood flow and volume in certain brain regions on the ipsilateral side. Inflammatory markers such as IL-6 and S100B decreased significantly within 24 hours. The intracranial pressure decreased, the cerebral perfusion pressure and the oxygen supply to the brain tissue improved after SGB. No adverse events were observed. Conclusion: SGB modulates cerebral hemodynamics and lowers intracranial pressure in patients with TBI, demonstrating its potential as a neuroprotective intervention. While these results highlight the therapeutic potential of SGB, further randomized controlled trials are needed to determine its optimal use and short-term and long-term benefits in the treatment of TBI. Trial Registration Number: NCT04208477. (© American Society of Regional Anesthesia & Pain Medicine 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Competing Interests: | Competing interests: None declared. |
| Contributed Indexing: | Keywords: Anesthesia, General; Anesthesia, Regional; Autonomic Nerve Block; Critical Care; Nerve Block |
| Molecular Sequence: | ClinicalTrials.gov NCT04208477 |
| Substance Nomenclature: | 0 (Anesthetics, Local) 0 (Inflammation Mediators) A5H73K9U3W (Levobupivacaine) |
| Entry Date(s): | Date Created: 20250219 Date Completed: 20260610 Latest Revision: 20260612 |
| Update Code: | 20260613 |
| DOI: | 10.1136/rapm-2024-106185 |
| PMID: | 39971387 |
| Βάση Δεδομένων: | MEDLINE |
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