Effect of ultrasound-guided stellate ganglion block on intraoperative hemodynamics in laparoscopic partial adrenalectomy: a randomized clinical trial

Purpose This study aimed to evaluate the effect of ultrasound-guided stellate ganglion block (SGB) on intraoperative hemodynamic parameters in patients undergoing laparoscopic partial adrenalectomy. Patients and methods A total of 72 patients with adrenal tumors scheduled for laparoscopic partial adrenalectomy were enrolled and randomly assigned in a 1:1 ratio to either the stellate ganglion block (SGB) group or the control group. The primary outcome was the incidence of intraoperative hypertension, defined as a systolic blood pressure (SBP) ≥180 mmHg or an increase of ≥30% in mean arterial pressure (MAP) from baseline. Secondary outcomes included MAP and heart rate (HR) measured at nine predefined perioperative time points, intraoperative vasoactive drug consumption, and the incidence of perioperative adverse events. Results The incidence of intraoperative hypertension was significantly lower in the SGB group than in the control group (14.3% vs. 37.1%, p = 0.029). Compared with the control group, patients in the SGB group exhibited significantly lower MAP and HR at eight time points ranging from immediately after tracheal intubation until the end of surgery ( p < 0.05). The intraoperative consumption of phentolamine was significantly lower in the SGB group than in the control group [0 (0–4) mg vs. 0 (0–0) mg; p = 0.008]. In contrast, the consumption of norepinephrine was significantly higher in the SGB group [0 (0–0) mg vs. 0 (0–8) mg; p = 0.004]. No statistically significant differences were observed between the two groups in the consumption of esmolol and atropine, or in the incidence of perioperative adverse events. Conclusion Ultrasound-guided SGB lowers intraoperative hypertension incidence and phentolamine demand in laparoscopic partial adrenalectomy. Although the SGB group observed a slight increase in the intraoperative dose of norepinephrine, no perioperative adverse events occurred. There was also no significant difference in the incidence of adverse reactions between the two groups.