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REGIONAL ANESTHESIA

Cervical Epidural Anesthesia for Combined Neck and Upper Extremity Procedure: A Pilot Study

Pavel Michalek, MD, PhD^*, Ivan David, MD, PhD, Milos Adamec, MD, PhD, and Libor Janousek, MD

*Department of Cardiovascular Anesthesia and Intensive Care, Na Homolce Hospital; and Department of Anesthesia and Intensive Care and Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Address correspondence and reprint requests to Pavel Michalek, MD, PhD, Department of Cardiovascular Anesthesia and Intensive Care, Na Homolce Hospital, Roentgenova 2, Prague 5, 15021 Czech Republic. Address e-mail to pafkam{at}seznam.cz

In a prospective pilot study, we evaluated the possibility of performing a total parathyroidectomy with parathyroid gland implantation into the forearm (a combined neck and upper extremity procedure) under cervical epidural anesthesia (CEA) at C6-7 level using ropivacaine. The indication for CEA was the patient’s choice or a previous procedure on the neck with unilateral vocal cord paralysis. Anesthesia was induced by 10 mL of 0.75% ropivacaine plus 10 µg of sufentanil in 2 mL. Block onset time, success rate, analgesia, sensory block extent, changes in respiratory and hemodynamic variables, complications, and length of hospital stay were assessed. All 15 procedures were successfully performed under CEA. Sensory block was registered in the range C2-T10, with a lower median of T3. The upper margin of sensory block was C2 in all patients. Of the respiratory variables, the only significant decrease was observed in forced vital capacity; none of the patients developed clinically significant respiratory insufficiency. We conclude that combined procedures involving the neck and upper limbs can be performed using CEA with ropivacaine. CEA allows verbal communication with patients and early detection of vocal cord paralysis.

IMPLICATIONS: We evaluated the efficacy and acceptability of cervical epidural anesthesia using ropivacaine for total parathyroidectomy with subsequent partial implantation of the gland into the forearm muscles (combined neck and upper extremity procedure). There were no complications or vital sign deterioration in 15 cases. Epidural anesthesia allowed the monitoring of vocal cord function.

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