Efficacy of Stellate Ganglion Block for Preventing Postoperative Atrial Fibrillation After Cardiac Surgery: A Randomized, Double‐Blind, Placebo‐Controlled Trial

Background Stellate ganglion block (SGB) may reduce postoperative atrial fibrillation (POAF) by modulating the autonomic nervous system. This study evaluated the efficacy of preoperative SGB in preventing POAF following cardiac surgery. Methods In this single‐center, randomized, double‐blind, placebo‐controlled trial, 140 patients undergoing valve surgery with cardiopulmonary bypass were assigned (1:1) to ultrasound‐guided right SGB with 7 mL of 0.5% ropivacaine or 7 mL of normal saline. The primary outcome was the incidence of POAF from postoperative day 0 to day 7 or until discharge. Results A total of 132 patients completed the study and were included in the modified intention‐to‐treat population (SGB group: n=65; saline group: n=67). POAF occurred in 43% of the SGB group and 40% of the saline group (odds ratio [OR], 0.99 [95% CI, 0.46–2.15], adjusted P =0.989). The SGB group demonstrated a lower incidence of intraoperative ventricular fibrillation/ventricular tachycardia requiring defibrillation after aortic cross‐clamp release (6% versus 19%; OR, 0.21 [95% CI, 0.06–0.80]; adjusted P =0.022), lower postoperative high‐sensitivity troponin I levels (median difference: −2562 ng/L [95% CI, −4301 to −45]; P =0.045), and a reduced risk of postoperative acute kidney injury (5% versus 18%; OR, 0.24 [95% CI, 0.06–0.98]; adjusted P =0.046). Conclusions While preoperative SGB did not reduce the incidence of POAF, it was associated with potential benefits, including a lower requirement for intraoperative defibrillation attributable to ventricular arrhythmias, attenuated myocardial injury (as indicated by lower high‐sensitivity troponin I levels), and a decreased risk of postoperative acute kidney injury. Registration URL: https://www.chictr.org.cn ; URL Identifier: ChiCTR2300068572.