[Cervical plexus block for carotid surgery. 313 consecutive operations]

The optimal method for protecting the brain from ischaemia during carotid surgery is still a matter of debate. The aim of this study was to report our early results after carotid surgery performed with cervical plexus blockade in vigilant patients.

From 1987 to 1992, 313 consecutive operations were performed on the carotid bifurcation (217 males, 96 females; mean age 67 years; age range 41-87 years). Thirteen underwent bilateral operations at a 1 month interval. There were 118 (38%) asymptomatic patients with carotid narrowing greater than 80% and 195 (62%) symptomatic patients including 96 with temporary cerebral ischaemia, 12 with regressive ischaemic events, 37 with cerebral vascular events and 50 with non-hemispheric events. The contralateral carotid artery was occluded in 30 patients (9.5%). Deep cervical blockade of the C2-C3-C4 roots then superficial blockade was obtained with 0.5% bupivacaine. Operations were endartectomy (n = 301; 96%) including 59 (18.5%) with a prosthetic patch, venous grafts (n = 8; 2.5%) and direct reimplantations (n = 3; 0.9%). All neurological complications observed during the 30 days following operation were recorded.

At occlusion, neurological events occurred in 40 patients (12.8%) and required the use of a temporary shunt. In patients with a contralateral occlusion such events occurred in 35.5% of the patients. No cases of myocardial infarction were observed and 1 patient died due to a neurological cause, giving a morbidity of 1.6% and a mortality of 0.3%.

Cervical plexus blockade was shown to be a simple and effective method for carotid surgery allowing good myocardial haemodynamics and a reliable evaluation of tolerance to occlusion.