Ultrasound-Guided Stellate Ganglion Block Regulates Inflammatory Cytokines and Improves Short-Term Outcome after Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial.

OBJECTIVES

To evaluate the effectiveness of left stellate ganglion block (SGB) for inflammatory cytokines and short-term outcomes in cardiac surgery with cardiopulmonary bypass (CPB).

DESIGN

Prospective, randomized, double-blinded clinical trial.

SETTING

Single academic center hospital.

PARTICIPANTS

We included patients aged 18 to 70 scheduled for cardiac surgery with CPB.

INTERVENTIONS: Before anesthesia induction, the patients who were allocated to either the SGB group or the control group received SGB using either 0.5% ropivacaine or 0.9% saline.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the inflammatory cytokine concentration before (T0) and 6 hours (T1), 24 hours (T2), and 5 days (T3) after the block. Secondary outcomes included the incidence of SIRS 24 hours after surgery, immune function at each time point, intraoperative and postoperative complications, 30-day mortality, intensive care unit and hospital stay, and hospitalization costs. The analysis included 25 SGB and 25 control patients. Compared with the control group, the SGB group significantly inhibited elevated TNF-α concentration at 6 hours and 24 hours after the block (p < 0.05). SGB significantly reduced the SIRS 24 hours after surgery, decreased the neutrophil percentage at 6 hours after the block, and increased the lymphocyte percentage at 5 days after the block. Additionally, SGB decreased the incidence of ventricular fibrillation after reperfusion, postoperative delirium, and the occurrence of Clavien-Dindo grade III-IV.

CONCLUSIONS

SGB effectively improves short-term outcomes in patients with cardiac surgery and CPB, possibly through modulating the neuro-endocrine-immune network to normalize sympathetic nervous system activity and stabilize perioperative tumor necrosis factor-α concentration.