SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
The Efficacy and Safety of Stellate Ganglion Block in Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- KA
Khadeeja Ali Hamzah 1
- YH
Yousif Hameed Kurmasha 2
- BA
Bilal Arshad 3
- WR
Waleed Rasheed 4
- MS
Muhammad Shahzaib 5
- MS
Mohammedsadeq Shweliya 6
- MA
Mohammad Al Diab Al Azzawi 7
1. University of Baghdad Al-Kindy College of Medicine, Baghdad, Iraq
2. University of Kufa College of Medicine, Najaf, Iraq
3. Shifa College of Medicine, Islamabad, Pakistan
4. The University of Jordan School of Medicine, Amman, Jordan
5. King Edward Medical University, Lahore, Pakistan
6. University of Baghdad College of Medicine, Baghdad, Iraq
7. The National Ribat University, Al-Ribat, Sudan
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Abstract
Background: Cardiac surgery induces sympathetic activation and inflammation, predisposing patients to peri-operative arrhythmias and delayed recovery. Stellate ganglion block (SGB) may attenuate this response. We evaluated the efficacy and safety of peri-operative SGB in adults undergoing cardiac surgery. Methods: We conducted a PRISMA-guided systematic review and meta-analysis of randomized controlled trials. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 23 October 2025 for trials comparing peri-operative SGB with control interventions, including standard care or active comparators, in adults undergoing cardiac surgery. Primary outcomes were postoperative atrial fibrillation (AF) and ventricular fibrillation (VF). Secondary outcomes included hemodynamic variables, peri-operative time metrics, intensive care unit (ICU) and hospital length of stay (LOS), the radio-femoral arterial pressure (RFAP) gradient, and SGB-related complications. Random-effects models were used to pool risk ratios (RRs) and mean differences (MDs). Results: Six RCTs were included. SGB reduced postoperative AF (4.0% vs 8.7%; RR 0.36, 95% CI 0.14–0.95) and VF (RR 0.30, 95% CI 0.12–0.74), and improved left ventricular ejection fraction (MD 0.93, 95% CI 0.23–1.63). SGB was associated with a higher RFAP gradient at early post-cardiopulmonary bypass time points and a shorter hospital LOS (MD −1.22 days, 95% CI −1.93 to −0.52). HR findings were non-significant across reported time points, whereas MAP findings varied by time point, with a significant reduction after bypass but no clear differences at other time points. Cardiopulmonary bypass time, aortic cross-clamp time, postoperative extubation time, ICU stay, intraoperative inotrope use, and surgery duration were not significantly different in the primary analyses. No serious SGB-related complications were reported. Conclusion: Peri-operative SGB may reduce postoperative AF and VF, improve LVEF, and shorten hospital stay in adults undergoing cardiac surgery, with no serious complications reported in the included trials. Hemodynamic effects appear time-point dependent, and larger multicentre randomized trials are needed to confirm these findings.
Summary
Keywords
CABG, cardiac surgery, Cardiopulmonary Bypass, Cervical sympathetic block, Coronary Artery Bypass, heart surgery, randomized controlled trial, rct
Received
24 February 2026
Accepted
08 July 2026
Copyright
© 2026 Hamzah, Kurmasha, Arshad, Rasheed, Shahzaib, Shweliya and Al Diab Al Azzawi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mohammad Al Diab Al Azzawi
Disclaimer
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