Cervical plexus anesthesia for carotid endarterectomy: comparison of ropivacaine and mepivacaine.
OBJECTIVE
To evaluate the effectiveness of cervical plexus block performed with ropivacaine 0.75% or 1%, or mepivacaine 2%.


METHODS
In a prospective, randomized, double-blind study, 60 patients received deep cervical plexus block with 0.2 ml x kg(-1) divided among C2-C4 injections using ropivacaine 0.75% and 1% or mepivacaine 2%. A blinded observer recorded loss of pin-prick sensation every minute in the C2-C4 dermatomes until readiness for surgery. Then, a superficial cervical block was performed with 0.15 ml x kg(-1) lidocaine 1%. The need for intraoperative supplemental analgesia and degree of pain and time of first postoperative pain medication were also recorded.


RESULTS
General anesthesia was not required to complete surgery in any case. No differences in the need for intraoperative supplemental analgesia was observed (7, 6, and 9 patients with ropivacaine 0.75% and 1% or mepivacaine 2%, respectively). Readiness to surgery required 15 (10-25) min with ropivacaine 0.75%, 18 (8-20) min with ropivacaine 1%, and 15 (5-20) min with mepivacaine 2% (P = NS); while patients asked for first postoperative pain medication after 10 (4-13) hr and 9 (6.5 - 11) hr with ropivacaine 0.75% and 1% compared with 5 (0-8) hr with mepivacaine 2% (P<0.05).


CONCLUSIONS
Ropivacaine 0.75% or 1% are appropriate choices when performing cervical plexus anesthesia for carotid endarterectomy, providing nerve block characteristics similar to those of mepivacaine 2%, but with the advantage of longer postoperative pain relief.
Leoni
A
A
Department of Anaesthesiology, University of Milan, Italy.
Magrin
S
S
Mascotto
G
G
Rigamonti
A
A
Gallioli
G
G
Muzzolon
F
F
Fanelli
G
G
Casati
A
A
D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000494:pharmacology*; D002572:Cervical Plexus; D004311:Double-Blind Method; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000494:pharmacology*; D008875:Middle Aged; D009407:Nerve Block; D011446:Prospective Studies; D000077212:Ropivacaine
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008619:Mepivacaine