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CARDIOVASCULAR ANESTHESIA

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

Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan

Address correspondence and reprint requests to Jaideep Pandit, DPHIL, FRCA, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK. Address e-mail to jpandit{at}talk21.com

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.

Implications: Carotid endarterectomy may be performed satisfactorily by using either superficial or combined block, and it is found that peroperative lidocaine requirements will be the same regardless of which block is used. The decision to use one block or the other might, therefore, reasonably be influenced by the relative safety of the superficial block compared with the combined block, because previous work suggests the deep injection is associated with a more frequent complication rate.

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