Carotid sinus nerve blockade to reduce blood pressure instability following carotid endarterectomy: a systematic review and meta-analysis.
OBJECTIVE
Local anaesthetic infiltration into the carotid sinus during carotid endarterectomy (CEA) has been recommended to minimise blood pressure fluctuations but its use remains controversial. The aim of this meta-analysis was to determine whether intra-operative administration of local anaesthetic reduces the incidence of haemodynamic instability following CEA.


METHODS
A search of the Medline, Pubmed and Embase databases and the Current Controlled Trials register identified four trials, which met the pre-defined inclusion criteria for data extraction. Pooled odds ratios with 95 per cent confidence intervals (c.i.) for the development of post-operative hypotension and hypertension were calculated using a random-effects model.


RESULTS
Outcomes of 432 patients were studied. Local anaesthetic blockade of the carotid sinus was associated with a pooled odds ratio of 1.25 (95 per cent c.i. 0.496 to 3.15); p=0.216) and 1.28 (95 per cent c.i. 0.699 to 2.33; p=0.428) for the development of post-operative hypotension and hypertension respectively. Although none reach significance there was a trend towards increased risk of developing a complication in those patients who received local anaesthetic.


CONCLUSIONS
There are insufficient data to determine the role of intra-operative local anaesthetic administration in reducing post-operative blood pressure lability following CEA. Conversely, the possibility of harm cannot be excluded on the basis of the currently available data.
Tang
T Y
TY
Cambridge Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Walsh
S R
SR
Gillard
J H
JH
Varty
K
K
Boyle
J R
JR
Gaunt
M E
ME
D000779:Anesthetics, Local / Q000008:administration & dosage*; D001340:Autonomic Nerve Block; D001794:Blood Pressure / Q000187:drug effects*; D002346:Carotid Sinus / Q000294:innervation*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007430:Intraoperative Care; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors
D000779:Anesthetics, Local