title: 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.
authors.affiliation: Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK. jaideep.pandit@physiol.ox.ac.uk
authors.forename: J J
authors.initials: JJ
authors.lastname: Pandit
authors.forename: R
authors.initials: R
authors.lastname: Satya-Krishna
authors.forename: P
authors.initials: P
authors.lastname: Gration
mesh_terms: D000768:Anesthesia, General; D002572:Cervical Plexus; D016894:Endarterectomy, Carotid; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods