Acta clinica Croatica, Vol. 47 No. 2, 2008.
Stručni rad
Superficial Versus Combined (Deep and Superficial) Cervical Plexus Block for Carotid Endarterectomy
Željko Ivanec
Branka Mazul-Sunko
Ivo Lovričević
Zdenko Sonicki
Aleksandra Gvozdenović
Katarina Kličan
Helena Krolo
Tomislav Halapir
Zdenko Novotny
Sažetak
It is not clear if any technique of regional anesthesia for carotid endarterectomy has an advantage over another. Therefore, we analyzed analgesic efficacy, side effects and complication rate in patients undergoing carotid surgery either under combined (deep and superficial) or superficial cervical block alone. Data on 324 patients that received either combined (n=107) or superficial (n=216) cervical block were prospectively analyzed. Data were collected on the intraoperative Verbal Analog Score (VAS), arterial pressure and heart rate. Analgesic efficacy was additionally assessed by the dose of supplemental 1% lidocaine and fentanyl and time before the first analgesic was administered at Intensive Care Unit. During surgery, VAS was slightly higher in the superficial group (median 0.6, range 0-3.9) than in the combined group (median 0.4, range 0-2.4; p<0.001). The median supplemental lidocaine dose during the operation was higher in the superficial block group (2.4 mg/kg, range 1.1-3.5) than in the combined group (2.1, range 0.5-3.4 mg/kg; p<0.001). Supplemental fentanyl was also higher in the superficial block group. There were no between-group differences in the time before the first postoperative analgesic, postoperative VAS and block-related complication rate. Accordingly, combined block provided a slightly better analgesia during the surgery, which was probably clinically irrelevant. There was no difference in postoperative analgesia and hemodynamic stability. So far, this is the largest prospective study in which superficial cervical block was found to be as efficacious as combined block which is associated with a considerably higher risk of complications.
Ključne riječi
Anesthesia, conduction - methods; Endarterectomy, carotid - methods; Endarterectomy, carotid - adverse effects; Nerve block - adverse effects
Hrčak ID:
27170
URI
Datum izdavanja:
2.6.2008.
Posjeta: 2.182 *