Regional anesthesia for carotid surgery.
OBJECTIVE
Evidence from retrospective studies suggests that regional anesthesia reduces the risks of major complications associated with carotid endarterectomy compared with general anesthesia, namely: stroke, stroke/death, death and myocardial infarction.


RESULTS
A superficial cervical plexus block is the regional anesthetic technique of choice. It is as efficacious as a combined (superficial and deep) cervical plexus block and carries substantially less risk of inducing a life-threatening complication from the block placement than a cervical epidural or a deep cervical plexus block. Lidocaine, mepivacaine, bupivacaine and ropivacaine are all suitable agents for this block but bupivacaine provides the longest duration of postoperative analgesia. The addition of epinephrine 1: 300,000 (3.75 microg/ml) reduces maximal blood concentrations of lidocaine and bupivacaine without inducing any adverse hemodynamic effects.


CONCLUSIONS
The anesthesiologist should learn how to place a superficial cervical plexus block. The technique is easy to master, effective and carries a low risk of inducing a serious complication.
Guay
Joanne
J
Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada. joanne.guay@umontreal.ca
D000779:Anesthetics, Local / Q000008:administration & dosage*; D002572:Cervical Plexus; D016292:Procedural Sedation / Q000379:methods; D016894:Endarterectomy, Carotid / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D006801:Humans; D016343:Monitoring, Intraoperative / Q000592:standards; D009407:Nerve Block / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D004837:Epinephrine