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PubMedDate not supplied

Ropivacaine 3.75 mg/ml, 5 mg/ml, or 7.5 mg/ml for cervical plexus block during carotid endarterectomy.

OBJECTIVE: To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of cervical plexus block during carotid endarterectomy. METHODS: Patients (n = 93) scheduled for carotid endarterectomy were randomized to receive a cervical plexus block with deep infiltration of 10 mL and superficial infiltration of 20-mL volumes of ropivacaine 7.5, 5.0, or 3.75 mg/mL. Pain, coughing, hemodynamic consequences of the block, postoperative visual analog scores, and pain satisfaction index were recorded. If necessary, anesthesia supplements with aliquots of 3 mL lidocaine 1% were given during surgery. RESULTS: Incidences of coughing and hoarseness were similar in all groups. More local anesthetic infiltrations were required in the ropivacaine 3.75-mg/mL and 5-mg/mL groups. Postoperatively, no intragroup differences were observed. A trend toward better pain satisfaction was observed in the ropivacaine 7.5-mg/mL group. CONCLUSION: The best quality of cervical plexus block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.

Aged↗
PubMed2006

Ultrasound guided deep cervical plexus block.

We describe a new technique for achieving a deep cervical plexus block using a portable vascular access ultrasound scanner (Site-Rite II, Bard Access Systems, Pittsburgh, PA).

Cervical Plexus↗
PubMed1999

[Superficial cervical plexus block in association with laryngeal mask in parathyroid surgery].

Superficial cervical plexus block in association with laryngeal mask for the airways control has improved the postoperative outcome, in comparison with a previous group in general anaesthesia, performed by the same equipment. The local anaesthetic infiltration as a preemptive analgesia give us good evidences in pain control. The laryngeal mask contributes to a good surgical field and avoid the neck hypertension.

Cervical Plexus↗
PubMed2005

Acute respiratory failure after deep cervical plexus block for carotid endarterectomy as a result of bilateral recurrent laryngeal nerve paralysis.

We report about a case of acute respiratory distress (73-year-old female), which occurred minutes after a deep cervical plexus block (40 ml ropivacaine 0.5%) for carotid endarterectomy (CEA) and required immediate endotracheal intubation of the patient's trachea and consecutive mechanical ventilation. Subsequently, CEA was performed under general anaesthesia (TIVA) with continuous monitoring by somatosensory-evoked potentials. After a period of 14 hours, the endotracheal tube could be removed, the patient being in fair respiratory, cardiocirculatory and neurological conditions. Retrospectively, acute respiratory distress was caused by a combination of ipsilateral plexus blockade-induced and pre-existing asymptomatic contralateral recurrent laryngeal nerve (RLN) paralysis confirmed by a postoperative ENT-check and related to previous thyroid surgery more than 50 years ago. RLN paralysis, often being asymptomatic, represents a typical complication of thyroid and other neck surgery with reported incidences of 0.5-3%. Therefore, a thorough preoperative airway check is advisable in all patients scheduled for a cervical plexus block. Particularly in cases with a history of respiratory disorders or previous neck surgery a vocal cord examination is recommended, and the use of a superficial cervical plexus block may lower the risk of respiratory complications. This may prevent a possibly life-threatening coincidence of ipsilateral plexus blockade-induced and pre-existing asymptomatic contralateral RLN paralysis.

Acute Disease↗
PubMed1990

Carotid endarterectomy under cervical plexus block--a prospective clinical audit.

One hundred and twenty-eight patients having carotid endarterectomy under superficial and deep cervical plexus blocks were prospectively audited. The aim of the audit was to determine the incidence of intra-operative and postoperative neurological and cardiovascular complications and to establish patient acceptance of the technique. Twenty-seven patients who had intra-operative neurological changes following carotid artery clamping responded to shunt insertion. Six patients had transient neurological changes after the operation but there were no permanent neurological complications. Tachycardia (55%) and hypertension (67%) were the most common intra-operative cardiovascular changes and there was one clinical postoperative myocardial infarction. Ninety-two per cent of patients who could be adequately assessed preferred to have the same method of anaesthesia for future carotid endarterectomy. The authors concluded that carotid endarterectomy under superficial and deep cervical plexus blocks was associated with a high patient acceptance, low neurological complication rate and an acceptable rate of cardiovascular complications.

Aged↗
PubMed1999

Cervical plexus block in adolescents.

In adults, peripheral nerve block provides an effective alternative to general anesthesia. In pediatric anesthesia practice, several factors may limit the use of such techniques. I present two adolescents in whom anatomical alterations precluded routine airway management. Cervical plexus block was used to provide surgical anesthesia for superficial/deep lymph node biopsy and excision of a thyroid nodule. The technique for cervical plexus block and its possible application in the practice of pediatric anesthesia are reviewed.

Adolescent↗
PubMed2006

The superficial cervical plexus block for postoperative pain therapy in carotid artery surgery. A prospective randomised controlled trial.

OBJECTIVES: Rapid and reliable neurological evaluation soon after carotid artery surgery is feasible with modern methods of general anesthesia, but postoperative pain therapy remains a challenge. Use of opioids can mask neurological deficits. We investigated whether superficial cervical plexus block reduced postoperative opioid consumption after carotid endarterectomy. DESIGN: Prospective, randomised, double-blinded, placebo controlled trial. METHODS: 46 patients undergoing unilateral carotid endarterectomy under general anesthesia were randomized to either superficial cervical block with ropivacaine (n=23) or placebo (n=23). A patient controlled analgesia device (PCA) delivering morphine was provided for all patients. Subjective pain levels (visual analog scale, VAS) were recorded. The primary outcome was total morphine consumption on discharge from the recovery room. Secondary outcomes included arterial pCO2 (as an indicator of central nervous effects of morphine) and patient satisfaction. RESULTS: No adverse effects of the superficial cervical plexus block were reported. Four patients in the placebo group were excluded because of other drug use post-operatively. Per protocol analysis compared 23 patients in ropivacaine group and 19 patients in the placebo group. The ropivacaine group had a significant reduction in morphine consumption (3.8+/-2.0 versus 12.9+/-4.0, p<0.001), lower maximal pain scores (2.6+/-2.0 versus 5.8+/-1.6, p<0.001), and paCO2 levels (39.0+/-2.6 versus 41.9+/-3.4, p=0.008) at discharge from the recovery room. Patient satisfaction (1=very good to 6=insufficient) was substantially higher in the ropivacaine group (1.7+/-0.7 versus 3.1+/-1.2, p<00.01). CONCLUSION: The significant and clinically relevant lower morphine consumption and pain score, as well as the substantially higher patient satisfaction demonstrate that superficial cervical plexus block provides effective pain relief for patients undergoing carotid endarterectomy.

Aged↗
PubMed2001

Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks.

Local anesthetic infiltration may reduce postthyroidectomy pain. We performed a double-blinded, randomized, placebo-controlled trial to assess the analgesic efficacy of bilateral superficial cervical plexus blocks performed at the end of surgery. Ninety patients undergoing elective thyroid surgery by the same surgeon under general anesthesia were randomized to receive 20 mL isotonic sodium chloride or 20 mL bupivacaine 0.25% with 1:200,000 epinephrine. Postoperative pain was assessed every 4 h using an 11-point numeric rating scale (NRS-11). All patients received acetaminophen every 6 h. In addition, morphine was administered following a standardized protocol if the NRS-11 score was > or = 4. The main outcome variables were pain scores (NRS-11), the proportion of patients given morphine at any time during the 24-h period, and the amount of morphine administered. The Bupivacaine group had a smaller proportion of patients given morphine (66.0% vs 90.0%; P = 0.016), and lower initial median pain scores (P = 0.002). We conclude that bilateral superficial cervical plexus blocks significantly reduce pain intensity in the postoperative period after thyroid surgery but do not provide optimal pain relief alone.

Analgesics, Opioid↗
PubMed2005

Superficial vs combined cervical plexus block for carotid endarterectomy: a prospective, randomized study.

BACKGROUND: The present study compares combined and superficial cervical plexus block in patients submitted to carotid endarterectomy (CEA) in terms of anesthetic efficacy, satisfaction of the patient and surgeon, complications resulting from the type of anesthesia, and final outcome. METHODS: A total of 125 patients submitted to elective CEA were randomized into 2 groups: the first group was submitted to superficial cervical block and the second group to combined (superficial plus deep) cervical block. RESULTS: No significant difference in anesthetic quality was observed between the 2 types of blocks. Complications related to the anesthetic method were observed in only 1 (1.6%) patient of the superficial block group and in 5 (7.4%) patients of the combined block group (P > .05). Anesthetic supplementation by the surgeon was necessary in 50 (81.96%) patients, with no significant difference between the 2 groups. The surgical conditions were closely similar in the 2 groups, showing no significant difference. The final morbidity and mortality in the present series was 1.6%. CONCLUSIONS: Superficial cervical anesthetic block shows the same efficacy as combined block, with the surgical conditions being closely similar. The incidence of complications related to the anesthetic technique is higher for combined block. The type of block does not influence the final outcome of the patients.

Aged↗
PubMed2006

Bilateral vocal cord palsy during carotid endarterectomy under cervical plexus block.

We describe a case of vocal cord palsy leading to respiratory obstruction during carotid endarterectomy under cervical plexus block in a patient who had preexisting contralateral vocal cord paralysis subsequent to a previous thyroidectomy. The patient required immediate tracheal intubation and subsequent tracheostomy to maintain the airway postoperatively. Care must be given to avoid contralateral vocal cord paralysis in the presence of a preexisting vocal cord palsy.

Aged↗
PubMed2002

Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block.

BACKGROUND: During carotid endarterectomy under regional anaesthesia, patients often require medication to control haemodynamic instability and to provide sedation and analgesia. Propofol and remifentanil are used for this purpose. However, the benefits, side-effects, and optimal dose of these drugs in such patients are unclear. METHODS: Sixty patients were included in a prospective, randomized, single blinded study. All patients received a deep cervical plexus block with 30 ml ropivacaine 0.75% and were randomized to receive either remifentanil 3 micro g kg(-1) h(-1) or propofol 1 mg kg(-1) h(-1). The infusions were started after performing the regional block and were stopped at the end of surgery. Arterial pressure, ECG, ventilatory rate, and Pa(CO(2)) were measured continuously and recorded at predetermined times. Twenty-four hours after surgery, patient comfort, and satisfaction were also evaluated. RESULTS: In three patients, the infusion of remifentanil had to be stopped because of severe respiratory depression or bradycardia. No significant differences were found between the two groups in haemodynamic variables or sedative effects, but there was a significantly greater decrease in ventilatory frequency and increase in Pa(CO(2)) in the remifentanil group. The patient's subjective impressions and pain control were excellent in both groups. CONCLUSION: As a result of the higher incidence of adverse respiratory effects with remifentanil and similar sedative effects, propofol is preferable for sedation during cervical plexus block in elderly patients with comorbid disease at the dosage used.

Aged↗
PubMed2005

The number of injections does not influence absorption of bupivacaine after cervical plexus block for carotid endarterectomy.

STUDY OBJECTIVE: To investigate the efficacy and kinetics of bupivacaine when used for deep cervical plexus block (CPB), using either a single-injection or multiple-injections technique. DESIGN: Prospective, randomized, double-blind study. SETTING: Operating room of a university hospital. PATIENTS: Twenty-four adult patients (16 men, 8 women) scheduled for carotid endarterectomy. INTERVENTIONS: Patients were randomly assigned to receive CPB either by a single injection or after 3 injections. Patients in the multiple-injections group received a total dose of 15 mL of 0.5% bupivacaine (5 mL each deposited at C2, C3, and C4 over 2 minutes). Patients in the single-injection group received a single 15-mL injection of 0.5% bupivacaine. After the deep CPB, a superficial CPB was performed with 20 mL of 0.5% bupivacaine in all patients. MEASUREMENTS: An anesthesiologist and a surgeon graded the success of the block. Arterial plasma concentrations of bupivacaine were measured using liquid chromatography-mass spectroscopy. MAIN RESULTS: No significant differences were seen between the 2 groups with respect to the mean peak concentration of bupivacaine (single injection 2314 +/- 1385 ng/mL vs multiple injections 2255 +/- 1105 ng/mL) or time to reach the maximal concentration (time to maximum concentration [single injection 12.1 +/- 7.2 minutes vs multiple injections 12.5 +/- 3.9 minutes]). Furthermore, there were no significant differences in mean block scores between the single-injection and the multiple-injections groups, evaluated either by the anesthesiologists or the surgeon. CONCLUSIONS: The results of this study showed that the absorption of bupivacaine is independent of the number of injections after CPB, and that anesthesia for carotid endarterectomy may be accomplished successfully using either technique.

Absorption↗
PubMed1996

Bilateral cervical plexus block for thyroidectomy and parathyroidectomy in healthy and high risk patients.

We evaluated the benefits of bilateral deep cervical plexus block regional anesthesia in healthy and high risk patients undergoing thyroid and parathyroid surgery and assessed its effects on respiratory function. Twenty-one patients undergoing thyroid and parathyroid operations were studied. Bilateral superficial and deep plexus blocks were performed in all patients except one (who received only superficial plexus block because of a slightly prolonged prothrombin time) with 0.375-0.5% bupivacaine with 1:200,000 epinephrine. Intraoperatively, supplemental intravenous sedatives/narcotics were titrated to achieve patient comfort and cooperation. To allay anxiety, patients were allowed to listen to music via headphones intraoperatively. Forced vital capacity was measured before block, 10 minutes after the block and in the recovery room in half the patients. Eighteen patients tolerated the procedure well with supplemental sedation. Two patients required supplemental inhalation anesthesia via mask and one required tracheal intubation because of coughing prior to surgery. Three high risk patients tolerated the procedure well requiring only intraarterial line monitoring. Postoperatively, 11 patients had minimal incisional pain, 13 patients had mild pain on swallowing and 2 patients complained of nausea. There were no significant differences in the baseline forced vital capacity vs. forced vital capacity measured after the block and in the recovery room. This study indicates that regional anesthesia is an appropriate alternative to general anesthesia in selected patients undergoing thyroid and parathyroid surgery and did not compromise respiratory function.

Adult↗
PubMed2026

Analgesia for Awake Internal Jugular Vein Cannulation in Trauma Emergency Bay: A Randomized Comparison of Ultrasound-Guided Superficial Cervical Plexus Block With Local Infiltration.

BACKGROUND: Internal jugular vein (IJV) cannulation is a critical component of trauma resuscitation but is often associated with significant pain during vessel dilation and suturing when performed under local anesthetic (LA) infiltration. OBJECTIVES: We hypothesized that an ultrasound (USG)-guided superficial cervical plexus block (SCPB) would provide superior analgesia and improve procedural efficiency in awake trauma patients compared to standard LA infiltration. METHODS: This was a prospective, randomized study of conscious, adult trauma patients requiring IJV cannulation. Participants were randomized to receive either 10 mL of 1% lignocaine via ultrasound-guided SCPB (Group S) or LA infiltration (Group L). The primary outcome was procedural pain measured by Numeric Rating Scale (NRS 0-10) during skin puncture, vessel dilation, catheter insertion, and suturing. Secondary outcomes included total procedure time, Verbal Numeric Rating Discomfort Scale (0-10), and complications. RESULTS: We enrolled 60 patients, with 30 patients assigned to each study group. Median NRS pain scores were significantly lower in Group S compared to Group L at all procedural time points (p < 0.01). The total procedure time was reduced by approximately 50% in Group S (7.5 min [interquartile range (IQR) 6.0-9.3]) compared to Group L (15.5 min [IQR 9.5-16.5]; p < 0.01). Patient discomfort scores were also significantly lower in Group S (p < 0.01). No periprocedural complications were reported in either group. CONCLUSION: Ultrasound-guided SCPB may be a useful alternative to local infiltration for IJV cannulation in selected awake trauma patients, when performed by clinicians experienced in ultrasound-guided regional anesthesia. By providing comprehensive sensory coverage, the technique significantly reduces procedural time and enhances patient cooperation without need for systemic sedation.

Humans↗
PubMed1993

Preventive superficial cervical plexus block for postoperative cervicocephalic pain in neurosurgery.

Eighty-six (54%) of a series of 160 patients who underwent neurosurgery experienced postoperative cervicocephalic pain. We performed a superficial cervical plexus block (SCPB) immediately after operation in the subsequent 240 patients, in which the incidence of postoperative cervicocephalic pain was reduced to 27% (65 patients), and the intensity of pain was apparently milder. SCPB is a worthwhile procedure to prevent postoperative cervicocephalic pain.

Cervical Plexus↗
PubMed2004

Superficial cervical plexus block for vocal cord surgery in an awake pediatric patient.

UNLABELLED: Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphonia and dysphagia in patients who have vocal cord paralysis. We report a case of a pediatric patient who underwent this procedure with minimal sedation and bilateral superficial cervical plexus blockade. The use of a regional technique provided analgesia while allowing the patient to phonate at the request of the surgeon. IMPLICATIONS: Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphagia and dysphonia in patients with vocal cord paralysis. This procedure is best performed in a patient who maintains the ability to phonate. We report a case of medialization thyroplasty in a pediatric patient after bilateral superficial cervical plexus blocks with minimal sedation.

Adolescent↗