Preoperative Stellate Ganglion Block for Postoperative Sore Throat in Patients Undergoing Double-Lumen Endotracheal Intubation: A Randomized Clinical Trial

Background: As a common complication of double-lumen endobronchial tube (DLT) intubation during thoracic surgery, postoperative sore throat (POST) brings adverse impacts on patient recovery. Although stellate ganglion block (SGB) can modulate sympathetic tone and inflammatory reactions, its efficacy in preventing DLT-related POST is still inconclusive. This trial aimed to determine whether SGB reduces the incidence of POST at 6 h after surgery in patients undergoing DLT intubation. Methods: In this single-center prospective randomized controlled trial, 124 patients undergoing elective thoracic surgery with left-sided DLT intubation were randomized 1:1 to two groups: the intervention group received preoperative ultrasound-guided right-sided SGB (5 mL of 0.5% ropivacaine), and the control group received standard care (ultrasound scanning without injection plus 1% tetracaine gel lubrication). The primary endpoint was the incidence of POST at 6 h after surgery. Results: Of the 124 randomized patients, 111 eligible subjects were finally included in the full analysis. The incidence of POST at 6 h after surgery, was significantly decreased in the ultrasound-guided SGB intervention group compared with the standard care control group (14.3% vs 38.2%; RR = 0.37; 95% CI: 0.18– 0.77; P = 0.008). This significant protective effect of SGB against POST was consistently observed at the early postoperative time point of 2 h ( P = 0.017) and sustained up to 24 h after surgery ( P = 0.036). SGB also significantly reduced POST severity at all time points, lowered sleep disturbance rate and improved anxiety/depression scores at 24 h after surgery (all P < 0.05). No between-group differences were observed in the incidence or severity of hoarseness or in other outcomes, and no notable complications occurred. Conclusion: Preoperative ropivacaine-based SGB could reduce the incidence and severity of POST in patients for DLTs in thoracic surgery, with this protective effect persisting for at least 24 h after surgery. These preliminary results require validation in larger multicenter studies. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR2400092313. Keywords: postoperative sore throat, stellate ganglion block, anxiety, double-lumen endobronchial tube, thoracic surgery