Ultrasound-guided locoregional anaesthesia for carotid endarterectomy: a prospective observational study

Introduction: Ultrasound guidance is increasingly used for invasive anaesthetic procedures to improve efficacy, facilitate performance and reduce risk of complications. Herein, we present a simple approach to ultrasound-guided locoregional anaesthesia for patients undergoing eversion carotid endarterectomy.

Methods: At the level of the base of the carotid bifurcation, the needle was inserted at the lateral border of the sternocleidomastoid muscle and, guided by ultrasound, advanced 0.5-1 cm posterolateral to the carotid artery, where ropivacaine (7.5 mg ml(-1)) was injected. During retraction of the needle, additional local anaesthetic was administered beneath the sternocleidomastoid muscle and, finally, subcutaneous infiltration along the surgical incision line was performed. The primary study end point was the amount of additional ropivacaine (7.5 mg ml(-1)) provided intra-operatively. Secondary measures included the occurrence of puncture-related complications and the adverse effects to locoregional anaesthesia.

Results: Sixty consecutive patients admitted for primary carotid endarterectomy were prospectively included. The volume of administered ropivacaine for locoregional anaesthesia and subsequent intra-operative supplementation was 31.7 ± 3.5 and 1.9 ± 2.5 ml, respectively. There were no conversions to general anaesthesia. Intravascular or subarachnoid injection of local anaesthetic did not occur, and symptoms of local anaesthetic systemic toxicity did not present. Related to the blockade, hoarseness (72%), Horner syndrome (37%), cough (20%), facial palsy (13%) and dysphagia (12%) were observed and resolved on the first postoperative day.

Conclusions: This observational study demonstrates that the described ultrasound-guided locoregional anaesthesia is suitable for eversion carotid endarterectomy and the amount of supplemental anaesthetic during the surgery is low.