title: Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A prospective, randomized, double-blinded trial.
  
  
  METHODS
  Education and research hospital.
  
  
  METHODS
  Adult patients undergoing carotid artery surgery.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Anaesthesiology and Reanimation. Electronic address: alisaitkavakli@hotmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Sait Kavaklı
authors.affiliation: Anaesthesiology and Reanimation.
authors.forename: Nilgün
authors.initials: N
authors.lastname: Kavrut Öztürk
authors.affiliation: Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Raif
authors.initials: R
authors.lastname: Umut Ayoğlu
authors.affiliation: Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Sağdıç
authors.affiliation: Anaesthesiology and Reanimation.
authors.forename: Gül
authors.initials: G
authors.lastname: Çakmak
authors.affiliation: Anaesthesiology and Reanimation.
authors.forename: Kerem
authors.initials: K
authors.lastname: İnanoğlu
authors.affiliation: Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Emmiler
mesh_terms: D000368:Aged; D000779:Anesthetics, Local; D016893:Carotid Stenosis / Q000601:surgery; D002572:Cervical Plexus / Q000000981:diagnostic imaging*; D066008:Cervical Plexus Block / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction; D011446:Prospective Studies; D066231:Surgeons; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: carotid endarterectomy; cervical plexus block; regional anesthesia; ultrasound guidance