Effect of Subarachnoid Injection of Papaverine on Mortality and Morbidity in Patients with Spontaneous Subarachnoid Hemorrhage and Cerebral Vasospasm

Vasospasm has been known as one of the major causes of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). This study aimed to evaluate the effect of subarachnoid injection of papaverine on mortality and morbidity in patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm. This controlled clinical trial was conducted from 2009-2010 at Alzahra University Hospital, Isfahan (Iran). Five patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm and needing ventriculostomy were included in the intervention group and undergone ventriculostomy and received papaverine (40 mg/12 h for 72 h) injection into the subarachnoid space. 10 patients with spontaneous subarachnoid hemorrhage accompanied with cerebral vasospasm (matching with age, sex, other disease, and subarachnoid hemorrhage severity) were included the control group and received standard treatment. Mortality, level of consciousness (GCS), hemodynamic and nervous system function changes were evaluated and compared before and 14 days after surgery. 9 women and 6 men were included in the study (mean age: 54.0 ± 12.8 years). The intervention and control groups were similar in baseline characteristics (P > 0.05). Only one person in the control group and none of the intervention group died two weeks after surgery (P = 0.667). After two weeks, mean of GCS had significant improvement in the intervention group (from 8.2 ± 1.6 to 12.8 ± 2.6; P < 0.008) but no change was seen in the control group (from 8.8 ± 1.8 to 9.0 ± 1.8; P = 0.729). This study indicated that a significant clinical improvement occurred after subarachnoid injection of papaverine in patients with spontaneous subarachnoid hemorrhage accompanied by cerebral vasospasm. This treatment has no beneficial effects on nervous complications. Future studies with larger sample size and longer follow-ups are recommended.