Anesth Pain Med.  2016 Oct;11(4):345-348. 10.17085/apm.2016.11.4.345.

Ultrasound-guided superficial cervical plexus block for carotid endarterectomy in a patient with Lemierre syndrome: A case report

• Choi YS
• Jo YY
• Jung WS
• Lee MG

• KMID: 2358328
• DOI: http://doi.org/10.17085/apm.2016.11.4.345

Abstract

A 70-year-old woman with an infectious thrombus in her left internal jugular vein (IJV) underwent carotid endarterectomy for stenosis and a highly movable plaque in her right carotid artery. She had been treated with antibiotics for four weeks before surgery due to Lemierre syndrome, a rare septic thrombophlebitis in the IJV secondary to an oropharyngeal infection. The right IJV was in a two-fold dilated state due to compensation for a thrombotic left IJV. Accordingly, superficial cervical plexus block was performed under ultrasound guidance to ensure safety and accuracy. During surgery, the alertness was maintained and the patient did not complain of pain in the absence of additional analgesics. No block-related complications were encountered. The authors report for the first time their regional anesthetic experiences in a patient with Lemierre syndrome.

Keyword

Carotid endarterectomy; Lemierre syndrome; Superficial cervical plexus block

MeSH Terms

Aged
Analgesics
Anti-Bacterial Agents
Carotid Arteries
Cervical Plexus Block*
Cervical Plexus*
Compensation and Redress
Constriction, Pathologic
Endarterectomy, Carotid*
Female
Humans
Jugular Veins
Lemierre Syndrome*
Thrombophlebitis
Thrombosis
Ultrasonography
Analgesics
Anti-Bacterial Agents

Figure

• 

  Fig. 1 (A) Head and neck CT image showing thrombosis in the left IJV (left black arrow) and a markedly dilated right IJV (right white arrow) caused by compensation for the thrombotic left IJV, and stenosis of the carotid artery (right black arrow) in frontal view. (B) Image showing thrombosis in the left sigmoid sinus (arrow) in axial view. IJV: internal jugular vein.

• 

  Fig. 2 (A) A 10 MHz linear transducer was positioned at the intersection of the SCM and external jugular vein in transverse position. Survey ultrasound scan showing the SCM, CA, IJV, and LSM. A 25-gauge, 2.54-cm needle (arrow) connected to a 10 ml syringe containing local anesthetic was advanced to the posterior border of the SCM muscle with penetration of the investing cervical fascia (asterisk). The right IJV was dilated to compensate for the left thrombotic IJV. (B) The transducer was then moved along the posterior border of the SCM vertically, and a total of 10 ml of local anesthetic was injected (asterisk) in a caudad and cephalad direction at the posterior border of the SCM. CA: Carotid artery, IJV: Internal jugular vein, LSM: Levator scapulae muscle, SCM: Sternocleidomastoid muscle.

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