Cervicothoracic Sympathetic Block for Long COVID

(CeASE Trial)

This trial tests a treatment called Cervicothoracic Sympathetic Block (CSB) to determine its effectiveness for Long COVID. Long COVID can cause symptoms like tiredness, brain fog, and heart palpitations, often linked to autonomic nervous system issues, which control automatic body functions. CSB uses a local anesthetic to calm overactive nerves, potentially reducing inflammation and improving symptoms. The study will compare the effects of CSB to a placebo (a harmless substance used for comparison) to evaluate its efficacy. Individuals who have had COVID-19 and continue to experience these symptoms for at least three months might be suitable candidates for this trial. As a Phase 4 trial, the treatment has already received FDA approval and proven effective, helping researchers understand its benefits for more patients.

Earlier studies have shown that a treatment called cervicothoracic sympathetic block (CSB) may help with long COVID symptoms. Research suggests that CSB works by blocking certain nerve signals, potentially reducing inflammation and improving blood flow to the brain.

Small studies involving 224 patients have examined CSB's effects. These studies indicate that the treatment might alleviate symptoms like tiredness, difficulty thinking clearly, and heart palpitations. However, these studies did not use a placebo for comparison, which could introduce bias in the results.

Researchers are excited about the Cervicothoracic Sympathetic Block (CSB) because it offers a novel approach to managing Long COVID symptoms. Unlike traditional treatments such as antivirals or corticosteroids that address viral load or inflammation, CSB targets the nervous system by blocking nerve signals. This method uses bupivacaine with epinephrine to potentially reduce persistent symptoms like fatigue and brain fog by modulating autonomic nervous system activity. This could provide faster relief and a different mechanism of action than current treatment options.

This trial will compare the effects of cervicothoracic sympathetic block (CSB) with a sham procedure for treating Long COVID symptoms. Studies have shown that treatments like CSB can help reduce symptoms in people with Long COVID. In one study, 86% of patients felt better after receiving a similar treatment called stellate ganglion block (SGB). CSB blocks nerve signals that keep the body in a "fight or flight" state, helping to calm the body and reduce inflammation. This is important because Long COVID symptoms often link to an overactive nervous system. While early studies are promising, more detailed research is needed to confirm these findings.¹²³⁴⁶