title: Anaesthesia for carotid endarterectomy. Ultrasound-guided superficial/intermediate cervical plexus block combined with carotid sheath infiltration.
abstract: BACKGROUND
  Carotid endarterectomy carries a significant risk of intraoperative brain ischaemia. Various methods for intraoperative cerebral function monitoring can be utilized, but the assessment of the patient's consciousness remains the easiest and most available method, requiring that the patient remain awake and under local/regional anaesthesia. The aim of this study was to compare infiltration anaesthesia with an ultrasound-guided superficial/combined cervical plexus block for patient safety and comfort.
  
  
  METHODS
  Ninety-eight patients scheduled for carotid endarterectomy were randomly assigned to receive either infiltration anaesthesia performed by the surgeon or an US-guided superficial/combined cervical plexus block. The pain intensity using the numerical rating scale (NRS), the volume of local anaesthetic used and the anaesthesia-related complications were recorded. The data were analysed using selected statistical tools.
  
  
  RESULTS
  In the US-guided group, a significantly lower volume of local anaesthetic was used (25 mL vs. 30 mL), and lower mean (1 vs. 3) and maximal (2 vs. 6) NRS scores were observed. However, hoarseness, cough and difficulty swallowing were significantly more frequent among those patients (90% vs. 27%, 30% vs. 12%, and 36% vs. 6%, respectively).
  
  
  CONCLUSIONS
  Compared with infiltration anaesthesia, an US-guided superficial/combined cervical plexus block is an effective method for improving the comfort of the patient and the surgeon. The technique is safe, relatively simple and easy to master and requires little time to perform.
authors: Department of Anaesthesiology and Intensive Therapy, 4th Military Teaching Hospital with Outpatient Clinic in Wrocław, Poland. pmadro@op.pl.
authors: Paweł
authors: P
authors: Mądro
authors: Alina
authors: A
authors: Dąbrowska
authors: Jarosław
authors: J
authors: Jarecki
authors: Piotr
authors: P
authors: Garba
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002572:Cervical Plexus / Q000000981:diagnostic imaging*; D066008:Cervical Plexus Block / Q000009:adverse effects / Q000379:methods*; D003371:Cough / Q000453:epidemiology / Q000209:etiology; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006685:Hoarseness / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D000070659:Patient Comfort; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local
keywords: anaesthesia; block; carotid endarterectomy; cervical plexus; ultrasound