Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy.
OBJECTIVES
Carotid endarterectomy under regional anesthesia may be performed by using superficial, intermediate, deep or combined cervical plexus block. The authors compared the combined and intermediate cervical plexus block by use of ultrasound guidance in patients undergoing carotid endarterectomy.


DESIGN
A prospective, randomized, double-blinded trial.


SETTING
Education and research hospital.


PARTICIPANTS
Adult patients undergoing carotid artery surgery.


INTERVENTIONS
Forty-eight patients were randomized to receive either combined cervical plexus block (deep plus superficial) or intermediate cervical plexus block by use of ultrasound guidance for carotid endarterectomy. The primary outcome measure was the amount of supplemental 1% lidocaine used by the surgeon. Secondary outcome measures were the time for the first analgesic requirement after surgery, block-related complications, postoperative visual analog scale score, and patient and surgeon satisfaction.


MEASUREMENTS AND MAIN RESULTS
Intraoperative supplemental lidocaine requirements were 3.0±1.9 mL in the combined-block group and 7.8±3.8 mL in the intermediate block group. These differences were statistically significant. There were no significant differences between the 2 groups in block-related complications and the time between the block completion and the first administration of the first dose of intravenous analgesic. In the combined-block group, maximum visual analog scale score was lower at 3 hours (2.2 [1-5] v 5.3 [3-8]), and patient satisfaction score was higher than the intermediate-block group (4.3 [3-5] v 3.1 [1-4]). One regional anesthesia procedure was converted to general anesthesia in the combined-block group.


CONCLUSIONS
Ultrasound-guided combined cervical plexus block compared to intermediate cervical plexus block led to less additional analgesic use, lower visual analog scale score, and higher patient satisfaction.
['Sait Kavaklı|Ali|A|', 'Kavrut Öztürk|Nilgün|N|', 'Umut Ayoğlu|Raif|R|', 'Sağdıç|Kadir|K|', 'Çakmak|Gül|G|', 'İnanoğlu|Kerem|K|', 'Emmiler|Mustafa|M|']
D000368:Aged D000779:Anesthetics, Local D016893:Carotid Stenosis D002572:Cervical Plexus D066008:Cervical Plexus Block D004311:Double-Blind Method D016894:Endarterectomy, Carotid D005260:Female D006801:Humans D008012:Lidocaine D008297:Male D008875:Middle Aged D010147:Pain Measurement D010149:Pain, Postoperative D017060:Patient Satisfaction D011446:Prospective Studies D066231:Surgeons D016896:Treatment Outcome D018084:Ultrasonography, Interventional
cervical plexus block ultrasound guidance carotid endarterectomy regional anesthesia