Stellate Ganglion Block Combined With Subanesthetic Ketamine Versus Dexmedetomidine for the Management of Paroxysmal Sympathetic Hyperactivity (PSH) After Traumatic Brain Injury: A Randomized Trial
4 affiliations
- 1Anesthesia Intensive Care and Pain Management Department Faculty of Medicine Zagazig University Alsharkia Egypt zu.edu.eg
- 2Faculty of Human Medicine Zagazig University Zagazig Alsharkia Egypt zu.edu.eg
- 3Dubai Hospital Dubai UAE dha.gov.ae
- 4Radiology Department Faculty of Medicine, Zagazig University Alsharkia Egypt
Abstract
Background: With appropriate treatment of paroxysmal sympathetic hyperactivity (PSH) following a traumatic brain injury, there is hope for individuals to overcome storming, regain consciousness, and progress toward successful recovery from the brain injury. The primary goal was to monitor changes in mean arterial blood pressure (MABP) in TBI patients with PSH treated with stellate ganglion block combined with subanesthetic dose ketamine versus dexmedetomidine infusion. The secondary outcomes included monitoring changes in heart rate, respiratory rate, temperature decline, duration of the resolution of paroxysmal hypermyotonia, Glasgow Coma Scale (GCS) grading, intensive care unit (ICU) stay, and the number of patients who did not show improvement.
Methods: This randomized, double‐blind controlled study was conducted on 102 patients with traumatic brain injury experiencing PSH. They were randomly allocated into two groups: the SK group (n = 51), where patients received a unilateral stellate ganglion block with 5 mL of bupivacaine 0.5% combined with 0.5 mg/kg/h intravenous subanesthetic ketamine infusion, and the D group (n = 51), where patients received a loading dose of 1 μg/kg dexmedetomidine for 10 min and then starting an intravenous infusion at a rate of 1 μg/kg/h.
Results: The D group exhibited a significant earlier decrease in MABP compared to the SK group at 30 min, 1, 2, 4, 8, 16, 24, and 48 h (p value = 0.0001). Both groups experienced similar reductions in RR at the same time points (p values ≥ 0.5). The temperature decreased after approximately 10 h from initiating treatment with no significant difference between the two groups. Four patients in the D group and three patients in the SK group did not show significant improvement. In terms of GCS, patients in both groups demonstrated significant improvement in GCS grading (18 [35.3%] Grade I, 29 [56.9%] Grade II, and only 1 [2.0%] and 3 [5.9%] Grades III and IV, respectively, in the D group, and 20 [39.2%] Grade I, 28 [54.9%] Grade II, and only 2 [3.9%] Grade III and 1 [2.0%] Grade IV in the SK group) (p = 0.0001). Both groups had similar durations of ICU stay (p = 0.222).
Conclusions: A unilateral stellate ganglion block combined with subanesthetic ketamine improves overall neurological recovery and ICU length of stay in post‐TBI PSH compared to continuous dexmedetomidine. However, dexmedetomidine provides a faster reduction in MABP and offers high practical value due to its noninvasive, intravenous delivery.
Trial Registration: ClinicalTrials.gov identifier: NCT06354673.
Related
- Rehabilitation of paroxysmal sympathetic hyperactivity secondary to severe brain injury: A case report.
- Fatal methanol poisoning with paroxysmal sympathetic hyperactivity, and putaminal hemorrhage: a case report and brief literature review
- Changes in parent-rated attention-deficit/hyperactivity disorder symptom scores and sleep parameters during individualized multidisciplinary clinical management in children with comorbid obstructive sleep apnea: a prospective cohort study in Vietnam
- Prevalence of adult attention-deficit/ hyperactivity disorder symptoms among university students and their relation to sleeping duration, time management skills, and academic performance
- Comparable Acute Antidepressant-like Effects of Two Subanesthetic Ketamine Doses Are Associated with Divergent Region-Specific Molecular Responses After Adolescent Chronic Stress
BibTeX
@article{mohamed2026stellate,
title = {{Stellate Ganglion Block Combined With Subanesthetic Ketamine Versus Dexmedetomidine for the Management of Paroxysmal Sympathetic Hyperactivity (PSH) After Traumatic Brain Injury: A Randomized Trial}},
author = {Eslam Sobhy Al Maghawry Mohamed and Alshaimaa Abdel Fattah Kamel and Abdalla Mohamed Goda Mohamed and Abd El-Rahman Wael Abd El-Rahman Ali Elmesallamy and Mohamed Gaber Mohamed and Michael Adel Shaker and Omar A. Khashaba and Marwa Mohamed Medhat},
journal = {Critical Care Research and Practice},
year = {2026},
month = nov,
doi = {10.1155/ccrp/2779975},
url = {https://doi.org/10.1155/ccrp/2779975},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stellate Ganglion Block Combined With Subanesthetic Ketamine Versus Dexmedetomidine for the Management of Paroxysmal Sympathetic Hyperactivity (PSH) After Traumatic Brain Injury: A Randomized Trial
AU - Eslam Sobhy Al Maghawry Mohamed
AU - Alshaimaa Abdel Fattah Kamel
AU - Abdalla Mohamed Goda Mohamed
AU - Abd El-Rahman Wael Abd El-Rahman Ali Elmesallamy
AU - Mohamed Gaber Mohamed
AU - Michael Adel Shaker
AU - Omar A. Khashaba
AU - Marwa Mohamed Medhat
PY - 2026
DA - 2026/11/04
JO - Critical Care Research and Practice
DO - 10.1155/ccrp/2779975
UR - https://doi.org/10.1155/ccrp/2779975
AB - Background: With appropriate treatment of paroxysmal sympathetic hyperactivity (PSH) following a traumatic brain injury, there is hope for individuals to overcome storming, regain consciousness, and progress toward successful recovery from the brain injury. The primary goal was to monitor changes in mean arterial blood pressure (MABP) in TBI patients with PSH treated with stellate ganglion block combined with subanesthetic dose ketamine versus dexmedetomidine infusion. The secondary outcomes included monitoring changes in heart rate, respiratory rate, temperature decline, duration of the resolution of paroxysmal hypermyotonia, Glasgow Coma Scale (GCS) grading, intensive care unit (ICU) stay, and the number of patients who did not show improvement. Methods: This randomized, double‐blind controlled study was conducted on 102 patients with traumatic brain injury experiencing PSH. They were randomly allocated into two groups: the SK group (n = 51), where patients received a unilateral stellate ganglion block with 5 mL of bupivacaine 0.5% combined with 0.5 mg/kg/h intravenous subanesthetic ketamine infusion, and the D group (n = 51), where patients received a loading dose of 1 μg/kg dexmedetomidine for 10 min and then starting an intravenous infusion at a rate of 1 μg/kg/h. Results: The D group exhibited a significant earlier decrease in MABP compared to the SK group at 30 min, 1, 2, 4, 8, 16, 24, and 48 h (p value = 0.0001). Both groups experienced similar reductions in RR at the same time points (p values ≥ 0.5). The temperature decreased after approximately 10 h from initiating treatment with no significant difference between the two groups. Four patients in the D group and three patients in the SK group did not show significant improvement. In terms of GCS, patients in both groups demonstrated significant improvement in GCS grading (18 [35.3%] Grade I, 29 [56.9%] Grade II, and only 1 [2.0%] and 3 [5.9%] Grades III and IV, respectively, in the D group, and 20 [39.2%] Grade I, 28 [54.9%] Grade II, and only 2 [3.9%] Grade III and 1 [2.0%] Grade IV in the SK group) (p = 0.0001). Both groups had similar durations of ICU stay (p = 0.222). Conclusions: A unilateral stellate ganglion block combined with subanesthetic ketamine improves overall neurological recovery and ICU length of stay in post‐TBI PSH compared to continuous dexmedetomidine. However, dexmedetomidine provides a faster reduction in MABP and offers high practical value due to its noninvasive, intravenous delivery. Trial Registration: ClinicalTrials.gov identifier: NCT06354673.
SN - 2090-1305
SN - 2090-1313
ER -