Author(s): Swati Verma, Manju Saxena, A. P. Bhalla, Supriya Aggarwal, Vidushi Sharma
BACKGROUND Carotid endarterectomy remains the gold standard in both symptomatic and asymptomatic carotid artery occlusive disease1 which can be performed either under general anaesthesia or regional anaesthesia using ultrasound guidance or landmark technique. We wanted to study the role of ultrasound in cervical plexus block as there has been no published work in the arena of ultrasound guided blocks in CEA. The main objective of the study is to compare the efficacy and safety of combined superficial and deep cervical plexus block in carotid endarterectomy patients using ultrasound guidance and landmark technique with general anaesthesia technique in terms of the local anaesthetic used for the block, supplemental local anaesthetic infiltration by the surgeons, patient and surgeons satisfaction, anaesthesia conversion rate in regional block, analgesic requirements intraoperatively, perioperative complications, hemodynamic instability and cost. METHODS 40 patients of ASA physical status II and III were operated between July 2010 and December 2013 at our Institute. Retrospective analysis of patient characteristics, anaesthetic technique and perioperative events was performed and the benefits of using ultrasound for cervical plexus block (CPB) were observed. Statistical Analysis of the data obtained was done using SPSS version 20 for Windows. RESULTS The dose of local anaesthetic bupivacaine was 85mg in ultrasound blocks and 105mg in landmark guided technique. 95.2% patients in ultrasound group had good muscle relaxation Grade 3 as described by surgeons and only 37.5% patients in landmark technique were relaxed well. None of the patients in ultrasound technique had requirements of additional local anaesthetic supplementation during surgery as compared to 62.5% patients in landmark group who required additional LA infiltration. Conversion rate to general anaesthesia was 4.7% in ultrasound group in contrast to 12.5% in landmark group. CONCLUSIONS Ultrasound guided superficial and deep cervical plexus block is more efficacious and safer than surface landmark technique in carotid endarterectomy surgery as there is reduction in local anaesthetic dose, no requirement of additional lignocaine infiltration, less conversion rate and perioperative complications, good patient and surgeon satisfaction and cost effective, under skilled and experienced anaesthesiologist.