Effects of ultrasound-guided stellate ganglion block in poststroke bulbar palsy: a double-blind placebo-controlled trial.

BACKGROUND

Bulbar palsy typically causes severe dysphagia. Based on rehabilitation interventions, stellate ganglion block (SGB) might improve swallowing function by regulating sympathoexcitation and cerebral perfusion. This study explored the short- and long-term effects of SGB on swallowing function, anxiety, and cerebral blood flow in patients with bulbar palsy after ischemic stroke.

METHODS

This randomized double-blind placebo-controlled trial included 124 participants in rehabilitation departments from March 2024 to July 2025 in China. The participants were randomized 1:1 to SGB or placebo groups, and all received routine treatment for 10 consecutive days. The SGB group received SGB with lidocaine hydrochloride, whereas the placebo group received block with normal saline. The primary outcome was the clinical severity of dysphagia. The secondary outcomes were airway protection, forward and upward movement distances of the hyoid bone, accumulation of secretions, pharyngeal residue, anxiety, and mean blood flow velocity (Vm) and internal diameter of the vertebral artery. The Vm and internal diameter were additionally assessed one hour after the first SGB. Repeated measures ANOVA and generalized estimating equations were used to explore time, group, and their interaction effects.

RESULTS

There were no significant baseline inter-group differences. After treatment, significant (P < 0.001) interaction effects were observed for dysphagia severity (η2 > 0.06), movement distances of the hyoid bone (η2 > 0.19), airway protection (β = - 0.774), pharyngeal residue (β < - 0.54), accumulation of secretions (β = - 0.371), and anxiety (η2 = 0.462). These effects remained significant at follow-up. After the first SGB, the Vm and internal diameter of the vertebral artery on the SGB side significantly increased (P < 0.001) in the SGB group, but the inter-group differences were non-significant after the intervention period.

CONCLUSIONS

In patients with bulbar palsy after ischemic stroke who receive routine treatment, SGB is safe and can effectively improve swallowing function, airway protection, and anxiety. The effects of SGB on vertebral artery blood flow are temporary, but the functional impacts are long-term.

TRIAL REGISTRATION: ClinicalTrials.gov. (Unique identifier: NCT06319534, 20/03/2024).