Ultrasound-guided intermediate versus deep cervical plexus block for carotid endarterectomy: a randomized controlled...

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Ultrasound-Guided Procedures

Background:

• Regional anesthesia, particularly cervical plexus blocks (CPBs), is preferred for carotid endarterectomy (CEA) due to stable hemodynamics and neuromotor assessment capabilities.
• Ultrasound guidance enhances visualization and safety during CPBs for CEA.
• This study compares the anesthetic efficacy of deep versus intermediate CPBs in patients undergoing CEA.

Purpose of the Study:

• To compare the anesthetic efficacy of deep and intermediate cervical plexus blocks (CPBs) in patients undergoing carotid endarterectomy (CEA).
• To assess the need for additional local anesthetic infiltration during CEA procedures under different CPB techniques.

Main Methods:

• A randomized, single-blind study involving 90 patients undergoing CEA, divided into intermediate (GI) and deep (GD) CPB groups.
• Data collected included additional lidocaine use, block performance time, needle insertions, sensory loss, pain scores, and patient/surgeon satisfaction.
• Evaluation of cutaneous sensory loss in four peripheral cervical plexus nerve territories was performed.

Main Results:

• Fewer patients in the deep CPB group (24.5%) required additional lidocaine compared to the intermediate group (47.5%) (p=0.03).
• Deep CPBs took longer to perform (320s vs. 208.5s) and involved more needle insertions (p=0.04).
• Patient satisfaction was higher in the intermediate CPB group (p=0.03), despite comparable pain scores and additional lidocaine amounts.

Conclusions:

• Deep cervical plexus blocks (CPBs) demonstrated superior anesthetic efficacy, requiring significantly less additional local anesthetic compared to intermediate CPBs during carotid endarterectomy (CEA).
• While deep CPBs were more effective in reducing supplementary anesthesia needs, intermediate CPBs resulted in higher patient satisfaction in this study.
• Ultrasound-guided deep CPBs offer a viable option for CEA anesthesia, though technique optimization may enhance patient experience.