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

Abstract

SummaryThe aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. Overall, 41 (35%) patients needed additional sedation (18 midazolam; 23 remifentanil). There was no intra-operative complication or systemic toxicity of ropivacaine. One regional anaesthesia procedure was converted to general anaesthesia because of patient agitation. Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.

Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy

“…There was no significant difference between two groups in block related complications and the time between the block completion and the first administration of the first dose of intravenous analgesic. In combined block group, maximum visual analog scale score was lower at 3 h (2.2 (1-5) vs 5.3 (3)(4)(5)(6)(7)(8)) and patient satisfaction score was higher than intermediate block group (4.3 (3-5) vs 3.1 (1-4)). One regional anaesthesia procedure was converted to general anaesthesia in combined block group.…”

“…This technique has been previously reported only in a study for the CEA, 6 and in a case report for partial thyroidectomy. 13 The technique of US-ICPB using the posterior approach requires the needle insertion lateral to the transducer to the posterior border of the sternocleidomastoid muscle.…”

“…In conclusion; anterior approach is apperantly easier than posterior approach. 6 By using ultrasound guidance, Calderone and colleagues 6 reported the warranty, efficacy and safety of intermediate CPB using anterior approach in a study performed in 116 patients. In their study; the incidence of LA supplementation (%51) and the volume of supplemental LA (approximately 10 ml) during CEA was similar to intermediate CPB group in our study.…”

“…To date, one study has described the technique of US-ICBP for carotid surgery using anterior approach and reported the easy to perform than the posterior approach. 6 Ultrasound guided deep CBP (US-DCPB) may allow direct spread of the anaesthetic injection around the cervical nerve plexus, and a reduction of complications due to entrapment of the LA in paravertebral space. 7 The vertebral artery and the C2-4 spinal nerves are in close anatomical proximity.…”

Monitoring regional blockade

“…used only sensory testing, as one would expect for a cervical block, but the three points of their 3‐point scale differed from that of Koh et al. . Kelpinger et al.…”