Superior autonomic regulation with ropivacaine over lidocaine in stellate ganglion block for chronic insomnia: a randomized controlled trial

This study aimed to compare the efficacy of lidocaine versus ropivacaine in stellate ganglion block (SGB) for insomnia treatment, including sleep quality improvement, symptom relief, and autonomic nervous system regulation. Sixty patients aged 18–75 years with insomnia were randomly divided into the ropivacaine group (Rop group) and lidocaine group (Lido group). Patients in Lido group received a 10-day SGB treatment using 0.8% lidocaine/3 ml. Patients in Rop group were treated with 0.2% ropivacaine/3 ml for SGB for 10 consecutive days. All patients received standard cognitive behavioral therapy. The results of Pittsburgh sleep quality index (PSQI), patient health Questionnaire-9 (PHQ-9), generalized anxiety Disord-7 (GAD-7) and heart rate variability (HRV) were observed and recorded before treatment (T1), the day after treatment completion (T2) and one month after treatment (T3). Within-group analyses revealed that both groups showed significant improvements in the global PSQI score at T2 and T3, compared to T1 (both P < 0.05). Scores for PHQ-9 and GAD-7 also decreased significantly at T2 compared to T1 in both groups (P < 0.05). In terms of HRV, the Lido group exhibited significant within-group decreases in RMSSD and SDNN at T2 (P < 0.05), while the Rop group showed significant within-group decreases in the LF/HF ratio at T2 (P < 0.05). Crucially, between-group comparisons at T2 found no significant differences in PSQI, PHQ-9, or GAD-7 scores (P > 0.05). However, a significant between-group difference was observed in the LF/HF ratio, with the Rop group demonstrating a significantly lower value [0.7(0.5,1.2)] compared to the Lido group [1.2(0.9,2.9)] (P < 0.05). SGB treatment with 0.2% ropivacaine and 0.8% lidocaine are equally effective for improving sleep and mood in insomnia. However, ropivacaine’s superior autonomic regulation makes it the preferred choice when mitigating sympathetic hyperactivity is a key therapeutic goal. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2500098835) on 2025/03/14.