Stellate Ganglion Block as Adjuvant Therapy to ca Channel Blocker
Condition: Subarachnoid Hemorrhage
MeSH terms: Subarachnoid Hemorrhage; Hemorrhage
Study type: Interventional
Phase: Phase 2

Summary: 
      Aim of work:

      To evaluate the effect of stellate ganglion block in prevention of cerebrovascular spasm in
      traumatic subarachnoid hemorrhage Primary outcome: Asses changes of cerebral blood flow
      velocity by Trans cranial Doppler.

      Secondary outcome: Asses changes in clinical status
    

Detailed description: 
      A subarachnoid hemorrhage is a relatively uncommon type of stroke incidence and impact of
      traumatic brain injury hemorrhage (aSAH) has been extensively studied; less is (TBI) within
      the general population have increased known regarding the epidemiology of posttraumatic
      passover the past few years . It accounts for about 1 in 20 (5%) of all strokes. In contrast
      to common types of stroke, subarachnoid hemorrhage often occurs at a relatively young age
      half the patients are younger than 60 years. The outcome of patients after subarachnoid
      hemorrhage is generally poor. One of the causes of poor outcome is due to spasm and lack of
      blood supply to brain this occurs four to ten days after the hemorrhage.

      Calcium antagonists as nimodipine are a type of drug that block calcium channels in cells and
      are often used for the treatment of high blood pressure. They have also been shown to
      counteract the narrowing of blood vessels after subarachnoid hemorrhage. Nimodipine is a
      dihydropyridine agent that blocks voltage-gated calcium channels and has a dilatory effect on
      arterial smooth muscle. It is the only FDA-approved agent for vasospasm with a half-life of
      about 9 h . Its beneficial effect on CVS derives most likely from its neuroprotective
      properties compared to arterial smooth muscle cell relaxation . The investigators can give
      nimodipine in several way as oral or IV and intrathecal .

      Stellate ganglion block (SGB) has an established use in treating patients with disorders
      mediated by the sympathetic nervous system in which pain and/or circulatory insufficiency are
      predominant symptoms. These disorders include Atypical angina , post-herpetic neuralgia and
      complex regional pain syndromes, such as reflex sympathetic dystrophy .In addition, SGB has
      also been used, albeit somewhat controversially, in management of traumatic brain edema,
      schizophrenia, and complicated cervical migraine. However, the use of cervical sympathetic
      block has been described in reversing delayed ischemic neurologic deficit following
      aneurysmal subarachnoid hemorrhage.

      The cerebral blood vessels, in particular the pia vessels, have a dense non-adrenergic
      sympathetic nerve supply that originates mainly in the cervical ganglia and accompanies the
      carotid artery to project into the ipsilateral hemisphere. There is controversy over the
      physiological significance of sympathetic innervation of the cerebral vasculature and the
      effect of SGB on it.The intracerebral vessels constrict in response to cervical sympathetic
      stimulation and dilate when these fibers are interrupted. The release and re-uptake of
      neurotransmitters, such as bradykinin, which is released during injury, can be prevented by
      sympathectomy. A recent report has suggested that cervical sympathetic block may be
      beneficial in patients with subarachnoid haemorrhage and that SGB may have therapeutic value
      in relieving cerebral vasospasm in certain neurological conditions. Anecdotal mention of SGB
      in some recent literature encourages the debate on its role as an adjunct to standard therapy
      for cerebral vasospasm, albeit, with a strong need for further evaluation
    

Intervention name(s): stellate ganglion block by transcranial doppler; Nimodipine
Intervention type(s): Procedure; Drug
Intervention description(s): stellate ganglion block is a block of sympathetic ganglion; Nimodipine 60mg every 4h
Intervention MeSH terms: Nimodipine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention