Publication:

Effect of stellate ganglion block on graft re-exploration rates in free flap graft placement surgeries in patients with head and neck cancer: a randomized controlled trial

Background Free flap reconstruction is frequently used after extensive head and neck cancer surgery. Sympathetic blockade may improve flap perfusion by reducing vasospasm. This study evaluated whether stellate ganglion block (SGB) reduces graft re-exploration in head and neck free flap surgeries.

Methods In this double-blinded randomized controlled trial, 70 patients undergoing free flap reconstruction were randomized to receive ultrasound-guided SGB with bupivacaine and triamcinolone (test group) or saline (control group). The primary outcome was grafting re-exploration. Secondary outcomes included graft failure and block-related adverse effects.

Results Baseline demographic and intraoperative characteristics were comparable between groups. Graft failure occurred in 5 patients in the control group and 2 patients in the test group (OR 3.33, 95% CI 0.55–20.22). Re-exploration was required in 1 patient in the control group and none in the test group (OR 3.36, 95% CI 0.13–88.39). No block-related adverse events occurred.

Conclusion Stellate ganglion block was safe and showed a trend toward reduced graft-related complications, although statistical significance was not achieved. Larger studies are needed to confirm these findings.