title: Ultrasound-guided intermediate cervical plexus block and perivascular local anesthetic infiltration for carotid endarterectomy : A randomized controlled trial.
abstract: OBJECTIVE
  Ultrasound-guided blocks of the cervical plexus are established anesthetic procedures for carotid endarterectomy. This randomized, double-blind, placebo-controlled study tested the hypothesis that an additional ultrasound-guided periarterial injection of local anesthetic leads to a lower frequency of periarterial supplementation by the surgeon.
  
  
  METHODS
  A total of 40 patients were randomly assigned to 1 of 2 groups. In both groups an ultrasound-guided intermediate cervical plexus block (20 ml of 0.75 % ropivacaine) at the level of the fourth cervical vertebra was performed. In a second step, the needle was inserted from posterolateral to anteromedial (in-plane technique) relative to the internal carotid artery and then, depending on the randomized group assignment, 5 ml of 0.75 % ropivacaine (group 2) or 5 ml of 0.9 % saline (group 1) was injected. The parameters investigated included the need for supplementation, patient comfort, the incidence of side effects and circulatory changes.
  
  
  RESULTS
  The two groups did not significantly differ (p = 0.459) in terms of the need for intraoperative supplementation with 1 % prilocaine with a mean (range) in group 2 of 4.9 ml (0-20 ml), in group 1 of 3.7 ml (0-16 ml) and patient comfort (p = 0.144). In addition, a trend towards a higher complication rate was observed in group 2.
  
  
  CONCLUSIONS
  For ultrasound-guided intermediate blocks of the cervical plexus, an additional periarterial infiltration showed no advantage. Abandoning this technique leads to a relevant simplification of the blocking technique and tends to reduce block-related side effects.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, HELIOS Medical Center Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Germany. ronald.seidel@helios-kliniken.de.
authors.forename: R
authors.initials: R
authors.lastname: Seidel
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, HELIOS Medical Center Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Zukowski
authors.affiliation: Institut of Anatomy, Medical University of Rostock, Rostock, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wree
authors.affiliation: Institut of Anatomy, Medical University of Rostock, Rostock, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schulze
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016893:Carotid Stenosis / Q000601:surgery; D002572:Cervical Plexus / Q000000981:diagnostic imaging*; D004311:Double-Blind Method; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D000070659:Patient Comfort; D011183:Postoperative Complications / Q000453:epidemiology; D011318:Prilocaine; D000077212:Ropivacaine; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D011318:Prilocaine; D000077212:Ropivacaine
keywords: Anesthesia, regional; Cervical plexus; Internal carotid artery stenosis; Randomized controlled trial; Ultrasonography