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

NCT ID: NCT06008795

Last Updated: 2025-11-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

195 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-17

Study Completion Date

2027-02-28

Brief Summary

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BLOCK-SAH is a phase II, multicenter, randomized, double-blinded, placebo-controlled clinical trial with a sequential parallel comparison design (SPCD) of bilateral pterygopalatine fossa (PPF) injections with 20mg ropivacaine + 4mg dexamethasone (active, PPF-block) compared to saline (placebo) for headache in survivors of aneurysmal subarachnoid hemorrhage (SAH), while monitoring intracranial arterial mean flow velocities with transcranial Doppler (TCD) peri-intervention (intervention = PPF-injections: active or placebo)

Detailed Description

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Conditions

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Subarachnoid Hemorrhage, Aneurysmal Headache

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Sequential Parallel Comparison Design
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Group 1 - Active - Active

Subjects randomized to Group 1 will receive an active PPF nerve block in Stage 1 followed by an active PPF nerve block in Stage 2 of the Double-Blinded Trial Phase

Group Type ACTIVE_COMPARATOR

Pterygopalatine Fossa Nerve Block with Ropivacaine and Dexamethasone

Intervention Type DRUG

Each PPF-active nerve block will consist of 20mg (4ml) ropivacaine plus 4mg (1ml) dexamethasone

Group 2 - Placebo - Active

Subjects randomized to Group 2 will receive a placebo PPF-injection in Stage 1 followed by an active PPF nerve block in Stage 2 of the Double-Blinded Trial Phase

Group Type OTHER

Pterygopalatine Fossa Nerve Block with Ropivacaine and Dexamethasone

Intervention Type DRUG

Each PPF-active nerve block will consist of 20mg (4ml) ropivacaine plus 4mg (1ml) dexamethasone

Placebo Pteryogpalatine Fossa Injection

Intervention Type PROCEDURE

Each placebo PPF-injection will consist of 5ml normal saline

Group 3 - Placebo - Placebo

Subjects randomized to Group 3 will receive a placebo PPF-injection in Stage 1 followed by a placebo PPF-injection in Stage 2 of the Double-Blinded Trial Phase

Group Type PLACEBO_COMPARATOR

Placebo Pteryogpalatine Fossa Injection

Intervention Type PROCEDURE

Each placebo PPF-injection will consist of 5ml normal saline

Interventions

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Pterygopalatine Fossa Nerve Block with Ropivacaine and Dexamethasone

Each PPF-active nerve block will consist of 20mg (4ml) ropivacaine plus 4mg (1ml) dexamethasone

Intervention Type DRUG

Placebo Pteryogpalatine Fossa Injection

Each placebo PPF-injection will consist of 5ml normal saline

Intervention Type PROCEDURE

Other Intervention Names

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Pterygopalatine Fossa Nerve Block

Eligibility Criteria

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Inclusion 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

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
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role collaborator

New York University

OTHER

Sponsor Role collaborator

Massachusetts General Hospital

OTHER

Sponsor Role collaborator

University of Florida

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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University of Florida

Gainesville, Florida, United States

Site Status RECRUITING

Emory University

Atlanta, Georgia, United States

Site Status RECRUITING

University of Maryland Baltimore

Baltimore, Maryland, United States

Site Status RECRUITING

Mayo Clinic

Rochester, Minnesota, United States

Site Status RECRUITING

Albany Medical College

Albany, New York, United States

Site Status RECRUITING

University of Rochester Medical College

Rochester, New York, United States

Site Status RECRUITING

University of Cincinnati

Cincinnati, Ohio, United States

Site Status RECRUITING

Oregon Health and Sciences University

Portland, Oregon, United States

Site Status RECRUITING

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status NOT_YET_RECRUITING

University of Washington

Seattle, Washington, United States

Site Status RECRUITING

Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Yurerkis Montas

Role: CONTACT

617-866-9758

Ralisa Pop

Role: CONTACT

352-294-5693

Facility Contacts

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Carolina Maciel, MD MSCR

Role: primary

352-273-5500

Christine Spainhour

Role: primary

404-727-1558

David Oriko

Role: primary

410-328-7822

Amy Headlee

Role: primary

Mahtab Sheikh

Role: primary

518-262-5883

Tilor Hallquist

Role: primary

585-275-3709

Alexandra Ramirez

Role: primary

513-558-0101

Sarah Feller

Role: primary

503-494-6233

Danna Smith

Role: primary

215-955-2173

Do Lim

Role: primary

206-744-9389

Jacob Labinski

Role: primary

414-805-2578

References

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Busl KM, Smith CR, Troxel AB, Fava M, Illenberger N, Pop R, Yang W, Frota LM, Gao H, Shan G, Hoh BL, Maciel CB; BLOCK-SAH Investigators. Rationale and Design for the BLOCK-SAH Study (Pterygopalatine Fossa Block as an Opioid-Sparing Treatment for Acute Headache in Aneurysmal Subarachnoid Hemorrhage): A Phase II, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial with a Sequential Parallel Comparison Design. Neurocrit Care. 2025 Feb;42(1):290-300. doi: 10.1007/s12028-024-02078-z. Epub 2024 Aug 13.

Reference Type DERIVED
PMID: 39138719 (View on PubMed)

Other Identifiers

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1U01NS124613-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB CED000000829

Identifier Type: -

Identifier Source: org_study_id

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