Influence of Anatomic Conditions on Efficacy and Safety of Combined Intermediate Cervical Plexus Block and Perivascular Infiltration of Internal Carotid Artery in Carotid Endarterectomy: A Prospective Observational Trial

Christopher Uhlig; Oliver Vicent; Stephanie Spieth; Stefan Ludwig; Christian Reeps; Axel R Heller; Koch Thea; Peter Markus Spieth; Thomas Rössel

doi:10.1016/j.ultrasmedbio.2021.05.014

Influence of Anatomic Conditions on Efficacy and Safety of Combined Intermediate Cervical Plexus Block and Perivascular Infiltration of Internal Carotid Artery in Carotid Endarterectomy: A Prospective Observational Trial

Ultrasound Med Biol. 2021 Oct;47(10):2890-2902. doi: 10.1016/j.ultrasmedbio.2021.05.014. Epub 2021 Jul 27.

Authors

Christopher Uhlig¹, Oliver Vicent², Stephanie Spieth³, Stefan Ludwig⁴, Christian Reeps⁴, Axel R Heller⁵, Koch Thea², Peter Markus Spieth², Thomas Rössel⁶

Affiliations

¹ Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany.
² Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
³ Department of Radiology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
⁴ Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁵ Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany.
⁶ Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany. Electronic address: [email protected].

PMID: 34325958
DOI: 10.1016/j.ultrasmedbio.2021.05.014

Abstract

Ultrasound-guided intermediate cervical plexus blockade with perivascular infiltration of the carotid artery bifurcation perivacular block (PVB) is a reliable technique for regional anesthesia in carotid endarterectomy (CEA). We investigated the effect of the carotid bifurcation level (CBL) on PVB efficacy and safety in patients undergoing CEA. This prospective observational cohort study included 447 consecutive CEA patients who received PVB over a 6-y period. Vascular and neurologic puncture-related complications were recorded. The CBL was localized at the low level (C4 and C5 vertebra, low-level [LL] group) in 381 (85.2%) patients and at the high level (C2 and C3 vertebra, high-level [HL] group) in 66 (14.8%) patients. Local anesthetic supplementation by surgeons was necessary in 64 (14.3%) patients in the LL group and 38 (59.4%) patients in the HL group (p < 0.001) and was associated with a higher rate of central neurologic complications in the HL group (p = 0.031). Therefore, the efficacy of the PVB may be influenced by the CBL.

Keywords: Carotid artery; Carotid endarterectomy; Carotid surgery; Local anesthetic; Observational trial; Regional anesthesia; Ropivacaine; Ultrasound.

Publication types

Observational Study

MeSH terms

Carotid Artery, Internal
Cervical Plexus / diagnostic imaging
Cervical Plexus Block*
Endarterectomy, Carotid*
Humans
Prospective Studies
Ultrasonography, Interventional