Cervicothoracic Sympathetic Block Evaluation for Post COVID Condition
A Randomized Controlled Trial for Cervicothoracic Sympathetic Chain Block Against Placebo Saline Injection Evaluation for Post COVID Condition: the CeASE RCT
- Autonomic Dysfunction
At a glance
- Phase
- Phase 4
- Study type
- Interventional
- Sponsor
- University Health Network, Toronto
- Enrolment target
- 78
- Started
- 19 May 2026
- Main results due
- 20 May 2027
- Study sites
- 2
- Registry updated
- 29 September 2026
Can you take part?
- Aged 18 years and over.
- Open to any sex.
- You need the condition being studied — healthy volunteers are not accepted.
These are the headline rules only. Every study has a longer list, and whether you are eligible is decided by the research team at the site — never by this page.
Read the full eligibility criteria
Inclusion criteria 1. Age 18 years or older 2. PCC following COVID-19 infection with symptoms lasting for at least three months 3. Ability to read, write, and understand English 4. Quantified autonomic symptoms from at least one domain as reported by the patient on the screener Composite Autonomic Symptom Score (COMPASS-31), i.e. a COMPASS-31 score greater than 0. COMPASS-31 assesses 6 domains of autonomic symptoms: Orthostatic Intolerance, Vasomotor, Secretomotor, Gastrointestinal, Bladder, and Pupillomotor. 5. Patients should be stable on any PCC-related medications for at least four weeks. Exclusion criteria 1. History of co-existing conditions that are a contraindication for CSB: 1. Unilateral vocal cord paralysis; Severe chronic obstructive pulmonary disease (FEV1 between 30-50% of predicted value) 2. Recent myocardial infarction (within the last one year), Cardiac conduction block of any degree 3. Glaucoma 4. Infection or mass at injection site, bleeding disorders 2. Comorbid conditions that could confound study results, such as: 1. Active autoimmune disorders 2. Pre-existing autonomic dysfunction (e.g. POTS, IST, and CRPS) prior to COVID-19 3. Untreated psychiatric conditions (e.g. severe anxiety or PTSD requiring medication adjustments during the study period) 3. Recent history of major surgery or cerebrovascular events within the last three months 4. Allergy to local anesthetic; Inability to extend the neck for any reason (e.g. severe arthritis) 5. History of prior stellate ganglion block
What this study is about
In the sponsor’s own words, from the registry.
Post-COVID Condition (PCC) affects roughly 2.1 million Canadians, carrying an annual economic burden of CAD $7.8-50.6 billion. It presents across multiple organ systems with symptoms including fatigue, brain fog, palpitations, and orthostatic intolerance, at an annual cost of CAD $1,675-$7,340 per case.
A key mechanism underlying many treatment-resistant PCC symptoms appears to be dysautonomia abnormal autonomic nervous system function driven by immune-mediated sympathetic overactivity. Persistent inflammation (cytokine storms, T/B-cell dysfunction, microclots) sustains sympathetic hyperactivity, which in turn perpetuates systemic inflammation and "sickness behaviors" resembling PCC symptoms.
Current treatments including beta blockers, ivabradine, fludrocortisone, and rehabilitation are limited by variable responses, side effects, and the complication of post-exertional symptom exacerbation. Emerging therapies (SSRIs, low-dose naltrexone, antihistamines, HBOT) show promise but lack robust trial evidence.
Cervicothoracic sympathetic chain block (CSB) a local anesthetic block of the cervical and upper thoracic sympathetic ganglia is a promising intervention that reduces sympathetic outflow, improves cerebral blood supply, and lowers pro-inflammatory cytokines. Small observational studies (16 studies, 224 patients) show benefit for PCC symptoms, but all lack placebo controls and have significant methodological heterogeneity.
The proposed study aims to fill this gap with a double-blind, placebo-controlled RCT to rigorously evaluate CSB's efficacy, magnitude of benefit, and durability in PCC patients.
Study sites(2)
Women's College Hospital
Toronto, Ontario, Canada
Not yet recruiting
Toronto Western Hospital
Toronto, Ontario, Canada
Recruiting
Showing 2 of 2 sites. 1 of the 2 sites on this study is recruiting right now — a site can stop enrolling while the study as a whole is still open.
Source: ClinicalTrials.gov record NCT07468604. Trialion does not run this study, is not paid to refer anyone to it, and cannot enrol you. Eligibility is always decided by the research team at the site.
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