Comparison of superficial cervical plexus block and combination of superficial cervical plexus and carotid sheath block in carotid endarterectomy: a prospective randomized study
Block onset time and duration of sensory block in patients having received both superficial cervical plexus block and carotid sheath block in carotid endarterectomy: a prospective randomized study
University Hospital Centre Sestre Milosrdnice
60 participants
Sep 15, 2022
Interventional
Conditions
Summary
The purpose of the research is to determine whether the combination of superficial cervical and "carotid sheath" block in carotid endarterectomy can improve the important aspects of the block: speed of onset of action and duration of analgesia. After obtaining approval from the ethics committee, sixty consecutive patients undergoing elective carotid endarterectomy with critical stenosis (>70%), ASA II or III status will be included in the study. Demographic and clinical data will be recorded on a standardized form. Patients will not receive any premedication. All patients chosen will be ASA grade II and III and have invasive blood pressure monitoring with parameters noted every 5 minutes. Both groups will receive a mixture of 2 mg/kg 0.5% levobupivacaine and 2 mg/kg 2% lidocaine supplemented with saline to a volume of 50 mL. The intervention will be delivered by an experienced anesthesiologist (defined as more than 10 years of experience). The onset and duration of sensory block and time to first analgesia will be recorded. Analgesia will be measured using numeric pain rating scale (NPRS) every 2 hours, up to 12 hours after regional block was performed. The age, gender, height and weight of the subject will be recorded. Intraoperative hemodynamic parameters and blood loss will be recorded. Hypotension, defined as systolic blood pressure <70 mmHg, will be managed with 10 mg ephedrine boluses. Bradycardia (defined as heart rate <50/min) will be treated with 0.5 mg atropine. Side effects such as nausea, vomiting, hematoma at the injection site, signs of systemic toxicity of local anesthetics (dizziness, tinnitus, disorientation, drowsiness, tremors, convulsions, respiratory depression, cardiovascular depression) and post-block neuropathy will be recorded. Research hypothesis: The combination of superficial cervical and "carotid sheath" block in carotid endarterectomy affects the strength and duration of postoperative analgesia.
Eligibility
Inclusion Criteria1
- Patients with critical stenosis (>70%) of the carotid artery. ASA grade II and III.
Exclusion Criteria1
- Patients older than 80 years, hepatic dysfunction, severe malnutrition, morbid obesity (body mass index > 40), allergies to local anesthetics.
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Interventions
One group will receive a superficial cervical block and the other group will receive a combination of a superficial cervical and "carotid sheath" block with an ultrasound technique performed by an experienced anesthesiologist (defined as more than 10 years of experience in clinical practice). The anaesthetist who performs the procedure positions the patient in supine position, with the head resting on pillow, looking to the opposite side. With the patient in the proper position, the skin is disinfected and the transducer is placed at the midpoint of the sternocleidomastoid muscle. The cervical plexus is identified, the needle is passed with in-plane approach behind the sternocleidomastoid muscle, the tip is placed adjacent to the plexus, and 15mL of local anesthetic mixture is administered. The rest of the local anesthetic mixture (35 mL) is injected subcutaneous cephalad and caudad along the length of the sternocleidomastoid muscle posterior border, and along the lower edge of the body of the mandible. Ultrasound-guided superficial cervical block combined with "carotid sheath" block will be performed with the help of a high-frequency linear probe that will be placed on the lateral side of the neck at the midpoint of the posterior edge of the sternocleidomastoid muscle, so that the posterior edge of the sternocleidomastoid muscle is in the center of the screen. A carotid artery is identified. Then, a 25 G needle will be introduced from the posterior side through the skin and platysma, the tip of the needle is placed adjacent to the carotid artery and its sheath and a total of 15 mL of local anesthetic mixture will be injected circularly around the carotid artery. The rest of the mixture of a total of 40-50 mL will be distributed equally as in a superficial cervical block. Both groups will receive a total of 40-50 mL of the mixture; 2 mg/kg 0.5% levobupivacaine and 2mg/kg 2% lidocaine, supplemented with saline to the required volume. The procedure will be performed once only approximately 30 min prior to the surgical incision.
Locations(1)
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ACTRN12622001230741