BLOCK-SAH - PPF-Block for Post-SAH Headache

Launched by UNIVERSITY OF FLORIDA · Aug 18, 2023

Keywords

ClinConnect Summary

The BLOCK-SAH clinical trial is studying a new treatment to help manage headaches in people who have survived a specific type of bleeding in the brain called aneurysmal subarachnoid hemorrhage (SAH). In this study, participants will receive injections in a specific area of the face, either with a combination of medications aimed at reducing pain and inflammation or with a harmless saline solution (placebo). The trial aims to see if the injections can effectively relieve headache pain while also monitoring blood flow in the brain during the procedure.

To be eligible for this trial, participants must be between 18 and 85 years old and have recently experienced a spontaneous SAH due to a detected aneurysm. They should also be able to communicate their pain levels and may need to have been treated for their aneurysm before joining the study. If eligible, participants will receive either the active treatment or the placebo and will be monitored closely throughout the study. This trial is currently recruiting participants, and it’s important for interested individuals to discuss it with their healthcare provider to see if it's a good fit for them.

Gender

ALL

Eligibility criteria

• In order to be eligible to participate in this study, an individual must meet all of the following criteria:
• • 1. Provision of signed and dated ICF by participant or a legally authorized representative (LAR)
• • 2. Stated willingness to comply with all study procedures and availability for the duration of the study
• • 3. Male or female, aged ≥18 and ≤ 85 years
• • 4. Admitted with a primary diagnosis of spontaneous, non-traumatic, SAH within 72 hours of ictus hemorrhage
• 5. Disease-specific inclusion criteria:
• • 1. Spontaneous, non-traumatic SAH
• • 2. Subarachnoid pattern of hemorrhage warranting diagnostic DSA due to involvement of at least one of the following regions: quadrigeminal plate, prepontine cistern, perimesencephalic cistern, Sylvian fissure, or surrounding Circle of Willis
• • 3. Modified Fisher grade 1-4 (on presentation imaging)
• • 4. Hunt and Hess 1-3 or World Federation of Neurosurgeons grade 1-4 (on screening, included only if also fulfilling Glasgow Coma Scale verbal subscore ≥4)
• • 5. Minimum Glasgow Coma Scale verbal subscore of 4 (on screening)
• • 6. Able to verbalize pain scale scores according to 11-point numeric pain scale
• In order to be enrolled and undergo randomization in this study, an individual must meet all of the additional criteria:
• 7. Stabilization period criteria:
• • 1. A minimum of 4 hours from DSA with clipping or coiling procedure (whenever applicable)
• • 2. Successful treatment of culprit vascular lesion (i.e., ≥90% obliteration of aneurysm), when applicable
• • 8. Requiring a minimum of 15mg OME prn for headache analgesia during any 24-hour period during eligibility period
• Exclusion Criteria:
• An individual who meets any of the following criteria will be excluded from participation in this study:
• 1. Premorbid conditions:
• • 1. Pre-existing neurologic, psychiatric, or other condition that would confound neurologic assessment or would make difficult/impossible to accurately assess neurologic and/or functional outcome
• • 2. Pre-existing diffuse flow-limiting narrowing of arteries in the Circle of Willis, regardless of etiology (e.g., atherosclerosis, vasculitis, Moya-Moya syndrome)
• • 3. Prior use of opioid or barbiturate analgesics for at least two-thirds of the days in previous month, regardless of indication
• • 4. Diagnosis of substance use disorder in the previous year
• • 5. Infected or wounded skin, or a skin lesion at the site of puncture for PPF- injection
• • 2. Uncorrected coagulopathy
• • 1. Platelet count \< 50,000/μL, International Normalized Ratio (INR) \> 1.7
• • 2. Requiring use of systemic anticoagulation and antiplatelet therapy (except for aspirin monotherapy).
• 3. SAH-specific:
• • 1. Head trauma as etiology of SAH
• • 2. Infection as cause for aneurysm or SAH (i.e., mycotic aneurysms)
• • 3. Inability to successfully treat culprit vascular lesion
• • 4. Diffuse vasospasm on pre-enrollment diagnostic CTA or DSA. Vasospasm is defined as moderate-to-severe arterial narrowing on DSA or CTA not attributable to atherosclerosis, catheter-induced spasm, or vessel hypoplasia, as determined by a neuroradiologist or neurointerventionalist
• • 4. Standard pain regimen conditions
• • 1. Elevation of hepatic enzymes prohibiting use of scheduled APAP (i.e., AST or ALT \> 3x upper limit level)
• • 2. Chronic liver condition with absolute contra-indication for APAP (even at lower maximum daily doses)
• • 5. Participation in a concurrent investigational/interventional study (observational studies allowed)
• • 6. Known to be pregnant, or with a positive pregnancy test
• • 7. Allergy or intolerance to the medications used in the PPF-block (i.e., ropivacaine, dexamethasone) or standard pain regimen (APAP)
• • 8. Vulnerable populations such as prisoners and inmates (abiding GCP per the study IRB)
• • 9. Unable to receive first PPF-injection within 96 hours of ictus hemorrhage