Key result
Preemptive left stellate ganglion block significantly reduced the incidence of cardiac surgery-associated acute kidney injury compared to no block (14.5% vs. 40.6%, RR 0.351).
Why the study?
Acute kidney injury is a common and severe complication of cardiac surgery, and it remained unclear whether preemptive left stellate ganglion block can effectively prevent it.
Does preemptive left stellate ganglion block reduce the incidence and severity of acute kidney injury in adult patients undergoing cardiac surgery with cardiopulmonary bypass?
RCT (n=138)
Double-blind
Computer-generated random number table
No
Does preemptive left stellate ganglion block reduce the incidence and severity of acute kidney injury in adult patients undergoing cardiac surgery with cardiopulmonary bypass?
Relative Risk: 0.351 (95% CI 0.169–0.728)
Absolute Event Rate: 14.5% vs 40.6%
p-value: p=0.005
Preemptive left stellate ganglion block significantly reduces the incidence and severity of acute kidney injury in patients undergoing cardiac surgery with cardiopulmonary bypass.
May warrant preemptive left SGB in CPB surgery to lower CSA-AKI risk; provides first RCT evidence for this sympathetic modulation approach.
BACKGROUND: Acute kidney injury is a common and severe complication of cardiac surgery. A connection might exist between renal sympathetic nerves and left stellate ganglion. It remains unclear whether preemptive left stellate ganglion block (SGB) can effectively prevent cardiac surgery-associated acute kidney injury (CSA-AKI) in clinical practice. METHOD: Participants were randomly assigned to SGB group with 0.375% ropivacaine 5 ml performed post-general anesthesia induction or control group (no SGB). The primary outcomes were incidence and severity of CSA-AKI within 7 days postoperatively. Secondary outcomes were intraoperative resistive index (RI) and pulsatility index (PI) of left renal artery via TEE and perioperative IL-6, CRP, and norepinephrine. RR and 95% CI were calculated to compare outcomes between groups. Sensitivity analyses were performed to confirm robustness of findings. RESULT: A total of 138 participants were randomized for intention-to-treat (ITT) analysis (69 SGB, 69 control) and 119 for per-protocol (PP) analysis (59 SGB, 60 control). In the ITT analysis, the incidence of CSA-AKI was significantly lower in the SGB group than the control group (14.5% [10/69] vs. 40.6% [28/69], RR 0.351, 95% CI: 0.169-0.728, P = 0.005). The PP analyses (13.6% [8/59] vs. 41.7% [25/60], RR 0.325, 95% CI: 0.160-0.660, P = 0.001) demonstrated similar results. The severity of CSA-AKI was significantly lower in the SGB group than the control group (ITT and PP: P < 0.001). The RI and PI were significantly lower in the SGB group than the control group at post-CPB cessation ( P < 0.001 and P = 0.005, respectively). Postoperatively, the SGB group demonstrated significant reductions in IL-6, CRP, and norepinephrine (all P < 0.05). The sensitivity analysis confirmed the robustness of the observed effects, yielding an unadjusted benefit ratio of 0.244 (95% CI: 0.096-0.620, P = 0.003) for the incidence of CSA-AKI and 0.197 (95% CI: 0.082-0.468, P < 0.001) for its severity. CONCLUSION: Preemptive left SGB effectively reduces the incidence and severity of CSA-AKI in patients undergoing cardiac surgery under CPB.
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Zhou et al. (2025) conducted an RCT in Cardiac surgery-associated acute kidney injury (n=138). Preemptive left stellate ganglion block vs. No stellate ganglion block was evaluated on Incidence of cardiac surgery-associated acute kidney injury within 7 days postoperatively (RR 0.351, 95% CI 0.169-0.728, p=0.005). Preemptive left stellate ganglion block significantly reduced the incidence of cardiac surgery-associated acute kidney injury compared to no block (14.5% vs. 40.6%, RR 0.351).
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