Total intravenous anesthesia with superficial cervical block or morphine transition in patients undergoing carotid...

The aim of this study was compare the Aldrete score at 5 minutes of two groups of patients undergoing carotid endarterectomy with intravenous anesthesia, receiving either anesthetic superficial cervical plexus block or intravenous morphine as transition analgesia.

After Ethics Committee approval, this randomized, controlled, double-blind, single-center study was performed on patients undergoing carotid endarterectomy, who received total intravenous anesthesia with propofol and remifentanil infusion. After intubation, each patient was randomly assigned to Block (superficial cervical block with levobupivacaine before the surgical incision), or Morphine group (standardized dose of morphine 30 minutes before the end of surgery). In the recovery room, an investigator unaware of the patient randomization recorded time to extubation, Aldrete score, pain, nausea/vomiting, and shiver at T0 (time of extubation), and at 5 (T5), 10 (T10), and 30 minutes (T30) after extubation.

Sixty-four patients were studied. Time to extubation was 11 ± 6 min for Block and 20 ± 10 min for Morphine group (P>0.001). Median Aldrete score at T0 was 9 in the Block and 6.5 in the Morphine group (P<0.001), at T5 it was 8.5 and 7.0 (P<0.001), respectively. At T5, 29 (90.6%) Block and 8 (25%) Morphine patients had an Aldrete score ≥ 8 (P<0.001). Systolic blood pressure was higher in the Block than in Morphine patients at T0 and T5.

This study demonstrates shorter time to extubation and better emergence from anesthesia when total intravenous anesthesia is associated with superficial cervical block than with morphine as transition analgesia.