Abstract Details

Subarachnoid hemorrhage (SAH) represents one of the most common indications for Neuro-ICU admissions and is associated with an in-hospital mortality rate of ~20%¹. One of the primary drivers of morbidity and mortality in this population is cerebral vasospasm, which is estimated to occur in about 20-30% of SAH patients². Current treatments for cerebral vasospasm due to SAH, including triple H therapy, calcium channel blockers, and intra-arterial spasmolytics, show limited efficacy and are often short-lasting. While some evidence demonstrates efficacy of single dose or sequential SGB^3,4, very few studies have utilized continuous stellate ganglion blocks for prolonged treatment of cerebral vasospasm, and no standardized SGB protocol has been established specifically for SAH-associated vasospasm.

To establish a protocol for continuous stellate ganglion block (SGB) infusions for treatment of subarachnoid hemorrhage-induced cerebral vasospasm.

We propose a standardized protocol for initiating continuous SGB infusions in patients with SAH and subsequent cerebral vasospasm based on retrospective data from patients admitted at our institution and review of literature. 

We identified 7 patients who met criteria for inclusion. Patients were indicated for SGB infusion if they displayed clinical evidence of moderate or severe cerebral vasospasm that was minimally responsive to standard measures. Patients underwent ultrasound-guided continuous stellate ganglion block at level of C6 or C7 transverse processes, ipsilateral to the vasospastic intracranial vessel. They subsequently were treated with a bolus of 0.5% ropivacaine 5-10 mL, followed by an infusion of 0.2% ropivacaine 4-10 mL/hr. Presence of ipsilateral Horner’s syndrome was documented for each patient to ensure successful placement, and daily Transcranial Doppler values and clinical exam were monitored.

Continuous SGB infusions are a well-tolerated, relatively non-invasive, and possibly more sustained method for treatment of severe SAH-induced cerebral vasospasm. Further study is required to assess SGB efficacy as a stand-alone, adjunctive, and/or prophylactic treatment for cerebral vasospasm.