Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications †

Abstract

Carotid endarterectomy is commonly conducted under regional (deep, superficial, intermediate, or combined) cervical plexus block, but it is not known if complication rates differ. We conducted a systematic review of published papers to assess the complication rate associated with superficial (or intermediate) and deep (or combined deep plus superficial/intermediate). The null hypothesis was that complication rates were equal. Complications of interest were: (1) serious complications related to the placement of block, (2) incidence of conversion to general anaesthesia, and (3) serious systemic complications of the surgical-anaesthetic process. We retrieved 69 papers describing a total of 7558 deep/combined blocks and 2533 superficial/intermediate blocks. Deep/combined block was associated with a higher serious complication rate related to the injecting needle when compared with the superficial/intermediate block (odds ratio 2.13, P = 0.006). The conversion rate to general anaesthesia was also higher with deep/combined block (odds ratio 5.15, P < 0.0001), but there was an equivalent incidence of other systemic serious complications (odds ratio 1.13, P = 0.273; NS). We conclude that superficial/intermediate block is safer than any method that employs a deep injection. The higher rate of conversion to general anaesthesia with the deep/combined block may have been influenced by the higher incidence of direct complications, but may also suggest that the superficial/combined block provides better analgesia during surgery.

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.…”

Unexplained fever after bilateral superficial cervical block in children undergoing cochlear implantation: an observational study

“…13 In a systematic review comparing superficial to deep cervical block in adults undergoing carotid endarterectomy, more than 2,500 cases of superficial cervical block were reviewed and no serious complications, including respiratory distress secondary to diaphragmatic or vocal cord paralysis, were recorded. 14 In a cadaveric study, Pandit et al examined patterns of injectate spread after different cervical blocks. 15 Methylene blue was injected into the superficial cervical space in four cadavers, just under the investing cervical fascia (superficial cervical block).…”

Gambling with ethics? A statistical note on the Poisson (binomial) distribution

“…Serious complications after carotid endarterectomy [20]; mortality after pulmonary aspiration [24] $60 $100…”