Objective:

To compare outcomes and risk of cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) who have undergone a stellate ganglion block (SBG) compared to those who received standard of care.

Background:

One-third of survivors of subarachnoid hemorrhage experience either death or long-term disability due to delayed cerebral ischemia resulting from cerebral vasospasm. Stellate ganglion block (SGB) is a sympathetic nerve block technique that holds potential benefits for SAH patients; however, the extent of its effectiveness remains unknown.

Design/Methods:

We conducted a systematic review and meta-analysis in adherence to PRISMA guidelines. Literature searches encompassing MEDLINE, Embase, Cochrane, Prospero, Clinicaltrials.gov, Google Scholar, and the Stroke Trials Registry were carried out from inception to October 2023. Our search included randomized controlled trials and observational cohort studies comparing the efficacy of stellate ganglion block to standard care in patients with subarachnoid hemorrhage. Our primary outcomes of interest were mean cerebral blood flow velocity (CBFV) 24 hours after SBG at either the left or right middle cerebral artery, the incidence of cerebral vasospasm at 24 hours, and 90-day Modified Rankin Scale (mRS). Pooled effect estimates were calculated using a fixed-effects meta-analysis methodology.

Results:

Of 644 unique records identified, 5 studies, totaling 175 patients, fulfilled the eligibility criteria. Meta-analysis found a significant reduction in mean CBFV after 24 hours (SMD 1.33, 95% CI 1.08-1.583, p < 0.001), but no significant difference in incidence of vasospasm (RR = 0.31, 95%CI -0.53 - 1.14, p = 0.105) or 90-day mRS (RR = 0.72, 95%CI 0.21 - 1.23, p = .276) in patients treated with stellate ganglion block compared to standard of care.

Conclusions:

This meta-analysis indicated that SBG improves cerebral blood flow velocity at 24 hours, though no significant differences in vasospasm incidence or 90-day mRS were observed.