[Locoregional anesthesia by peri-dural route in neck surgery]

Principal anatomical "targets" and physiological consequences of cervical epidural anesthesia are outlined, technic and aims of the method discussed and 53 patients (class ASA I and II) receiving major cervical surgery, mainly for cancer, reviewed. Effectiveness of cervical epidural anesthesia was rated as excellent for total pharyngo-laryngectomy, with or without flaps, total laryngectomy, lymph node curettage and thyroidectomy, moderate for reconstructive laryngectomy and only fair for transmaxillary buccopharyngectomy. Advantages of the method concern principally the postoperative period: immediate awakening (92% of cases) in the operating room whatever the duration of surgery, avoiding intensive care, and pain relief for at least 48 hours (85% of cases) by maintenance of catheter. Contraindications include hypocoagulability, local or general infection and impossibility of adjusting heart rate, and the method is not applicable for all patients in whom general anesthesia with assisted ventilation is contraindicated.