Comparison of intermediate vs subcutaneous cervical plexus block for carotid endarterectomy.
Ramachandran SK., Picton P., Shanks A., Dorje P., Pandit JJ.
BACKGROUND: Carotid endarterectomy surgery can be performed under regional anaesthesia alone or under general anaesthesia. However, there are several types of regional block available and reported complication rates after superficial cervical plexus blocks are significantly lower than deep blocks. It is not known if subcutaneous and intermediate blocks are equally effective, although anatomical evidence suggests that the latter (where the injectate diffuses below the deep cervical fascia) might provide superior quality of intraoperative anaesthesia. METHODS: Forty-four patients were randomized to receive either subcutaneous or intermediate cervical plexus blocks for carotid endarterectomy. The primary endpoint was supplemental lidocaine requirement during surgery. Secondary outcome measures included: total amount of fentanyl administered during surgery, recall of pain scores during surgery, complications, and patient and surgeon satisfaction. RESULTS: There was no statistically significant difference for median (range) lidocaine supplementation between the subcutaneous and intermediate groups 65 (20-170) mg vs. 85 (30-345) mg, respectively; P=0.31. There were no statistical differences in the secondary outcome measures and no major complications during the study. CONCLUSIONS: Intermediate and subcutaneous cervical plexus blocks are equally effective for carotid endarterectomy. This study adds to the body of evidence supporting the safe use of superficial blocks for this type of surgery.