Efficacy of Stellate Ganglion Block for Preventing Postoperative Atrial Fibrillation After Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial.
Jun Zhang, Yeru Chen, Nuan Li et al.
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In 30 seconds
This single-center, randomized, double-blind, placebo-controlled trial assessed whether preoperative ultrasound-guided right stellate ganglion block (SGB) prevents postoperative atrial fibrillation (POAF) in patients undergoing valve surgery with cardiopulmonary bypass. Among 132 patients in the modified intention-to-treat analysis, POAF occurred in 43% with SGB and 40% with saline (OR, 0.99 [95% CI, 0.46-2.15]; adjusted P =0.989), showing no reduction. SGB was associated with fewer intraoperative ventricular arrhythmias requiring defibrillation, lower postoperative troponin I, and less acute kidney injury; these secondary findings warrant cautious interpretation.
Key findings
- POAF occurred in 43% with SGB versus 40% with saline (OR, 0.99 [95% CI, 0.46-2.15]; adjusted P =0.989).
- Ventricular fibrillation or tachycardia requiring defibrillation after aortic cross-clamp release occurred in 6% versus 19% (OR, 0.21 [95% CI, 0.06-0.80]; adjusted P =0.022).
- Postoperative acute kidney injury occurred in 5% with SGB versus 18% with saline (OR, 0.24 [95% CI, 0.06-0.98]; adjusted P =0.046).
- Postoperative high-sensitivity troponin I was lower with SGB (median difference: -2562 ng/L [95% CI, -4301 to -45]; P =0.045).
Why it matters
The trial does not support preoperative SGB as a means of preventing POAF in patients undergoing valve surgery with cardiopulmonary bypass. The observed differences in intraoperative ventricular arrhythmias, myocardial injury markers, and acute kidney injury may be clinically relevant, but they are secondary outcomes and do not establish that SGB improves these outcomes. The findings help distinguish the tested primary benefit from signals that need further evaluation.
What to keep in mind
The trial was single-center and included patients undergoing valve surgery with cardiopulmonary bypass; applicability to other cardiac surgery populations is uncertain. Eight of 140 assigned patients were not included in the modified intention-to-treat analysis.