Yeungnam Univ J Med.  2018 Jun;35(1):45-53. 10.12701/yujm.2018.35.1.45.

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

• Do W
• Cho AR
• Kim EJ
• Kim HJ
• Kim E
• Lee HJ

• KMID: 2415733
• DOI: http://doi.org/10.12701/yujm.2018.35.1.45

Abstract

BACKGROUND
Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.
METHODS
Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.
RESULTS
There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p < 0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p < 0.0001 between 0-6 h, p < 0.004 between 6-12 h, and p < 0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p < 0.001).
CONCLUSION
In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Keyword

Carotid endarterectomy; Cervical plexus block; Dexmedetomidine; General anesthesia; Ultrasonography

MeSH Terms

Adult
Anesthesia, Conduction
Anesthesia, General*
Anesthesia, Local
Antihypertensive Agents
Cervical Plexus Block*
Cervical Plexus*
Dexmedetomidine*
Endarterectomy, Carotid*
Hemodynamics
Humans
Length of Stay
Medical Records
Pilot Projects*
Postoperative Complications
Propofol
Retrospective Studies*
Ultrasonography
Vasoconstrictor Agents
Antihypertensive Agents
Dexmedetomidine
Propofol
Vasoconstrictor Agents

Figure

• 

  Fig. 1. Flow diagram of the patients.

• 

  Fig. 2. Frequency and timing of antihypertensive drugs (A) and inotropic or vasopressors (B) administrating during surgery. T1, during administration of dexmedetomidine or after intubation; T2, at skin incision; T3, before carotid artery cross-clamping; T4, after carotid artery cross-clamping; T5, at the end of the operation. a) p<0.005 compared with regional anesthesia group.

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