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

Eligibility Criteria

• 1. Provision of signed and dated informed consent form
• 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, subarachnoid hemorrhage within 48 hours of ictus hemorrhage
• 5. Disease-specific
• 1. Premorbid conditions:
• * 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
• * Pre-existing diffuse flow-limiting narrowing of arteries in the Circle of Willis, regardless of etiology (e.g., atherosclerosis, vasculitis, Moya-Moya syndrome)
• * Prior use of opioid or barbiturate analgesics for at least two-thirds of the days in previous month, regardless of indication
• * Diagnosis of substance use disorder in the previous year
• * Infected or wounded skin, or a skin lesion at the site of puncture for PPF-injection
• 2. Uncorrected coagulopathy
• * Platelet count \< 50,000/μL, International Normalized Ratio (INR) \> 1.7
• * Requiring use of systemic anticoagulation and antiplatelet therapy (except for aspirin monotherapy).
• 3. SAH-specific:
• * Head trauma as etiology of SAH
• * Infection as cause for aneurysm or SAH (i.e., mycotic aneurysms)
• * Inability to successfully treat culprit vascular lesion
• * Diffuse vasospasm on initial diagnostic CTA or digital subtraction angiography (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
• * Elevation of hepatic enzymes prohibiting use of scheduled acetaminophen (i.e., AST or ALT \> 3x upper limit level)
• * Chronic liver condition with absolute contra-indication for acetaminophen (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 (acetaminophen)
• 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