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

Regional anesthesia is commonly preferred technique for carotid endarterectomy (CEA) as it allows neuromotor evaluation and provides more stable hemodynamics. Cervical plexus blocks (CPBs) including superficial, intermediate and deep, are used alone or in combination in carotid surgery. Ultrasound guidance provides better visualization with increased safety for CPBs. The aim of this study is to compare the anesthetic efficacy of deep and intermediate CPBs by assessing the number of patients requiring additional local anesthetic during CEA.

In this randomized, single-blind study, we enrolled 90 patients who underwent CEA. Patients who received either intermediate or deep CPB were divided into two groups: Group of Intermediate (GI) and Group of Deep (GD). The number of patients requiring additional lidocaine infiltration, time spent for block performance, extra number of needle insertions and orientations, assessment of cutaneous sensory loss in four peripheral cervical plexus nerve territories (lesser occipital, supraclavicular, transverse cervical and great auricular), pain scores, amount of additional lidocaine and complications were recorded. Patient and surgeon satisfaction were also evaluated.

Nineteen out of 40 patients (47.5%) in GI and 10 out of 41 patients (24.5%) in GD needed additional lidocaine infiltration intraoperatively (p = 0.03). Time spent for intermediate block was 208.5 (50-332) s and for deep was 320 (90-780) s (p < 0.001). The blocks were performed successfully with single needle orientation 85% of GI and in 68% of GD (p = 0.11). The number of extra needle insertions was significantly higher in GD compared to GI (1 [1-4] and 1 [1-2], respectively; p = 0.04). All patients achieved adequate cutaneous sensory loss for surgery. Pain scores and amount of additional lidocaine were comparable. Patient satisfaction was significantly higher in GI than in GD (p = 0.03).

In this study we found that significantly fewer patients required additional lidocaine in deep CPB than in intermediate CPB with low initiation LA volumes under USG guidance.

The study was registered at ClinicalTrials.gov (registration number NCT05353218) on 24/04/2022.