Frontiers in neurology · 2026
The effect of preoperative stellate ganglion block on postoperative delirium in elderly patients undergoing gastrointestinal oncologic surgery: protocol for a randomized, double-blind, sham-controlled trial.
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Song Rongrong, Huang Yuqin, Liu Jie, Wang Xingyu, Liu Yuqian, Wang Fanli, Wu Fang, Li XiaXia, Liu Yang, Cao Lu, Liu Yan, Wang Guojieying, Gui Minghong, Wang Yingbin, Huang Xiangfei
Аннотация
BACKGROUND: Postoperative delirium (POD) is a common and severe complication in elderly patients following gastrointestinal oncologic surgery, associated with prolonged hospitalization, increased morbidity and mortality, and substantial healthcare costs. The stellate ganglion block (SGB), a sympathetic nerve block with anti-inflammatory and autonomic-modulating effects, has shown promise in improving perioperative outcomes. However, high-quality randomized controlled trials evaluating its efficacy in preventing POD in this older population are lacking.
METHODS: This is a single-center, prospective, randomized, double-blind (participants and outcome assessors), sham- controlled trial. A total of 174 elderly patients (≥60 years) scheduled for elective radical gastrointestinal cancer surgery will be randomized in a 1:1 ratio to receive either two ultrasound-guided SGBs (one on the afternoon before surgery and one 30 min before anesthesia induction) with 0.375% ropivacaine (3-5 mL each) or a sham block with normal saline (3-5 mL). All patients, surgeons, and outcome assessors will be blinded to group assignment. A standardized anesthesia protocol and a multicomponent delirium- prevention bundle will be applied to all participants. The primary outcome is the cumulative incidence of POD within postoperative days 1-3, assessed twice daily using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM). Secondary outcomes include delirium severity and duration, postoperative recovery (Quality of Recovery-15 score), inflammatory biomarkers (procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), lymphocyte-to-monocyte ratio [LMR], neutrophil-to-lymphocyte ratio [NLR]), pain trajectories, opioid consumption, and length of hospital stay.
EXPECTED OUTCOMES: We hypothesize that preoperative SGB will reduce the incidence and severity of POD compared to a sham block. This study will provide preliminary evidence on the feasibility and efficacy of SGB as a targeted intervention for high-risk older surgical oncology patients, while acknowledging that the assumed effect size may be optimistic.
CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=302103, identifier: ChiCTR2600118223.
METHODS: This is a single-center, prospective, randomized, double-blind (participants and outcome assessors), sham- controlled trial. A total of 174 elderly patients (≥60 years) scheduled for elective radical gastrointestinal cancer surgery will be randomized in a 1:1 ratio to receive either two ultrasound-guided SGBs (one on the afternoon before surgery and one 30 min before anesthesia induction) with 0.375% ropivacaine (3-5 mL each) or a sham block with normal saline (3-5 mL). All patients, surgeons, and outcome assessors will be blinded to group assignment. A standardized anesthesia protocol and a multicomponent delirium- prevention bundle will be applied to all participants. The primary outcome is the cumulative incidence of POD within postoperative days 1-3, assessed twice daily using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM). Secondary outcomes include delirium severity and duration, postoperative recovery (Quality of Recovery-15 score), inflammatory biomarkers (procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), lymphocyte-to-monocyte ratio [LMR], neutrophil-to-lymphocyte ratio [NLR]), pain trajectories, opioid consumption, and length of hospital stay.
EXPECTED OUTCOMES: We hypothesize that preoperative SGB will reduce the incidence and severity of POD compared to a sham block. This study will provide preliminary evidence on the feasibility and efficacy of SGB as a targeted intervention for high-risk older surgical oncology patients, while acknowledging that the assumed effect size may be optimistic.
CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=302103, identifier: ChiCTR2600118223.