Carotid endarterectomy with intermediate cervical plexus block

Area of Science:

• Anesthesiology
• Vascular Surgery
• Neurosurgery

Background:

• Traditional superficial and deep cervical plexus blocks for carotid endarterectomy carry risks of cardiovascular, respiratory, and neurologic complications.
• There is a need for safer and simpler anesthesia techniques for this procedure.

Purpose of the Study:

• To evaluate the feasibility, effectiveness, and safety of an intermediate cervical plexus block combined with subcutaneous infiltration for carotid endarterectomy.

Main Methods:

• 183 patients undergoing primary carotid endarterectomy received an intermediate cervical plexus block using 0.75% ropivacaine, combined with subcutaneous infiltration of the incision line.
• Intraoperative topical lidocaine or intravenous sedation/analgesia was used as needed.
• Needle insertion was perpendicular to the skin along the sternocleidomastoid muscle's posterior border.

Main Results:

• The technique was feasible and effective, with only 1.1% of procedures converted to general anesthesia.
• Low complication rates were observed: 1.6% experienced postoperative stroke or myocardial infarction.
• No perioperative deaths or major complications occurred.

Conclusions:

• The intermediate cervical plexus block is a safe, feasible, and effective anesthesia method for carotid endarterectomy.
• This technique offers a reduced risk profile compared to traditional combined superficial and deep cervical plexus blocks.
• Further research can explore optimizing this anesthesia approach for carotid endarterectomy.