Publication: Department of Veterans Affairs, Veterans Health Administration,Quality Enhancement Research Initiative, Health Services Research & Development Service
Washington, DC 20420
Date: February 2017
Author: Evidence-based Synthesis Program (ESP), Coordinating Center, Portland VA Health Care System, Portland, OR, Mark Helfand, MD, MPH, MS, Director
Emergence of an intervention’s first randomized trial is always a highly anticipated event. For SGB, however, findings from its first randomized trial for PTSD proved to be disappointing. In uncontrolled, unblinded, retrospective case series, SGB for PTSD had high rates of rapid clinical improvement in PTSD symptoms (70% to 75%). In the RCT, the range of mean percent PTSD improvement after one round of SGB was 5.4% to 14.7%, and was 12.1% to 21.2% after the second round, which was no better than an injection of saline. The RCT was too small to estimate complication rates and did not report the number of patients in each group, if any, who responded to treatment. Instead it reported group averages. What do we make of this? It is not surprising that SGB’s benefits were less impressive in the RCT than in the case series, as empirical evaluation has shown that, on average, benefits are generally larger in observational studies.66 However, what was surprising is that by using a somewhat lower than usual dose of ropivacaine (5 cc versus 7 cc) and a population that may have been motivated to resist treatment, design features may have limited the RCT’s chances of generating meaningful data on efficacy.71 Substantial uncertainty remains about the potential harms of SGB as well, as the RCT and previous case series in PTSD, as well as RCTs for CRPS, 68 were inadequately powered to support or refute findings from the 1992 German questionnaire survey of 45,000 SGBs. We agree with the conclusions of previous reviews that further research is needed to more precisely determine the balance of benefits and harms of SGB for PTSD.39,52,72.
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