A Comparison of Superficial Versus Combined (Superficial and Deep) Cervical Plexus Block for Carotid Endarterectomy: A Prospective, Randomized Study

Abstract

Carotid endarterectomy may be performed by using cervical plexus blockade with local anesthetic supplementation by the surgeon during surgery. Most practitioners use either a superficial cervical plexus block or a combined (superficial and deep) block, but it is unclear which offers the best operative conditions or greatest patient satisfaction. We compared the two techniques in patients undergoing carotid endarterectomy. Forty patients undergoing carotid endarterectomy were randomized to receive either a superficial or a combined cervical plexus block. Bupivacaine 0.375% to a total dose of 1.4 mg/kg was used. The main outcome measure was the amount of supplemental lidocaine 1% used by the surgeon. Subsidiary outcome measures were postoperative pain score, sedative and analgesic requirements before and during surgery, and postoperative analgesic requirements. Median supplemental lidocaine requirements were 100 mg (range 30-180 mg) in the superficial block group and 115 mg (range 30-250 mg) in the combined block group. These differences were not statistically significant (Mann-Whitney U-test). There was no significant difference in the number of patients needing postoperative analgesia between the groups (11 of 20 in the deep block group versus 8 of 20 in the superficial block group) in the 24 h after surgery. The median time to first analgesia in the superficial block group was 150 min, more than in the combined block group (median time 45 min) but this difference, although large, was not statistically significant (Mann-Whitney U-test). We found no significant differences between the anesthetic techniques studied. All patients reported satisfaction with the techniques.

Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial

“…[18][19][20][21][22][23][24] Several studies have shown that the SCPB not only improves pain control after thyroidectomy and carotid endarterectomy, [18][19][20][21][22][23][24] but it also decreases PONV after thyroidectomy. 18 Nevertheless, we did not find any differences in postoperative opioid consumption between the two groups.…”

Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study

“…As definitions of cervical plexus blocks where hitherto somewhat confusing, the nomenclature has been helpfully systematised, with ICPB defined as the injection of local anaesthetic between the superficial and the deep cervical fascia [15]. In a study by Pandit et al performed in 40 patients, the use of superficial plexus block for carotid endarterectomy using ropivacaine 0.375% provided similar efficacy to that provided by a combined (deep and superficial) cervical plexus block [16]. The volume of supplemental local anaesthesia (approximately 10 ml) needed for the superficial or combined plexus blocks was similar to the one used in this study, although lidocaine 1% was used in Pandit et al's study and lidocaine 2% in ours.…”

Anesthesia for carotid endarterectomy: where do we stand at present?

“…Superficial block is as effective as a deep or combined block if the amount of local anesthetic supplementation by the surgeon is used as a measure of block efficacy, (9) and other measures of block effectiveness (pain scores, postoperative analgesia), which were also not different between the two types of regional anesthesia. (13) …”