Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

Abstract

BackgroundCarotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.MethodsMedical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.ResultsThere was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p<0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p<0.001).ConclusionIn this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Ultrasound-guided intermediate cervical plexus block for postoperative analgesia in patients undergoing carotid endarterectomy under general anesthesia: a case-control study

“…[18] In a more recent study, Do et al mentioned that ultrasoundguided cervical plexus block leads to both a more stable hemodynamic and lower pain scores compared to general anesthesia. [19] As expected, in our study, patients who had ICPB in addition to general anesthesia presented with lower acute pain scores and reduced opioid consumption. Based on this, we think that it would be more appropriate to review the standardization of general anesthesia technics for CEA in the literature and to make comparisons accordingly.…”

Anesthetic Management of a Patient Undergoing Cochlear Implantation With Superficial Cervical Plexus Block and Sedation: A Case Report

“…10 A SCPB is commonly used with general anesthesia for surgery near the superficial cervical plexus sensory area, such as clavicle fracture repair, shoulder joint surgery, and carotid endarterectomy. 11 Several case reports have described the use of a SCPB for ear pain caused by trauma or surgery. 12 Bilateral cochlear implants with general anesthesia and a SCPB have been reported.…”

Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy

“…To check the association between the theoretically harmful perioperative stress [ 5 , 15 , 44 ] and brain metabolism, we decided to analyze the correlation of multiple parameters potentially related to stress, frailty and cerebral injury.…”