title: Safety and efficiency of ultrasound-guided intermediate cervical plexus block for carotid surgery.
abstract: OBJECTIVE
  Since stroke and myocardial ischaemia are major causes of perioperative morbidity and mortality associated with carotid endarterectomy, monitoring the brain and ensuring the best haemodynamic stability are important goals of the management. As regional anaesthesia was reported to improve haemodynamic stability during carotid endarterectomy (CEA), we conducted a prospective observational study on the efficacy and safety of ultrasound-guided intermediate cervical plexus blocks (CPB), with early (immediate postoperative) and mid-term (day 30) outcomes in awake patients undergoing CEA.
  
  
  METHODS
  After the ethics committee approval, 50 patients undergoing a carotid endarterectomy with CPB from April 2011 to May 2013 were included. Anaesthesia and surgical dissection parameters, early complications and haemodynamic stability were recorded, as well as neurologic and cardiac outcomes initially and one month later.
  
  
  RESULTS
  Cervical space was easy to locate by ultrasound in 90% of the patients. The quality of anaesthesia and surgical dissection was good in 86 and 88% of patients, respectively. No conversion to GA was required, secondary to a lack of analgesia. Two patients (4%) had severe hypotension (<100mmHg). Three patients required a shunt after carotid clamping for loss of consciousness with a favourable neurological outcome. We observed one elevation of cTnI (0.95ng·ml(-1)) without ECG change and 1 death occurred after a postoperative haemorrhagic stroke.
  
  
  CONCLUSIONS
  The present work reports our first 50 cases of intermediate CPB using ultrasound guidance. The results underline that this technique is easy to perform, safe and reliable, provided good surgical conditions with continuous intraoperative neurologic monitoring and stable haemodynamics are respected.
authors.affiliation: Department of Anaesthesia, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France. Electronic address: ileblanc@for.paris.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Leblanc
authors.affiliation: Department of Anaesthesia, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Chterev
authors.affiliation: Department of Anaesthesia, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rekik
authors.affiliation: Department of Vascular Surgery, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Boura
authors.affiliation: Department of Vascular Surgery, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Costanzo
authors.affiliation: Department of Anaesthesia, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bourel
authors.affiliation: Department of Vascular Surgery, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Combes
authors.affiliation: Department of Anaesthesia, institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris cedex 14, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Philip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002572:Cervical Plexus / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014474:Unconsciousness / Q000209:etiology
keywords: Carotid surgery; Cervical plexus block