Comparison of two methods of cervical plexus block for carotid endarterectomy

BACKGROUND: Cerebral thromboembolism is one of the main risks of carotid artery occlusive disease. Carotid endarterectomy is a preventive operation to reduce the incidence of embolic stroke. Of prime concern during this surgery is protection of the brain during carotid cross-clamping. Since blood flow to the brain is provided via the non-affected carotid artery and collateral circulation, it is essential to maintain the consciousness of the patient during surgery in order to assess the effects of cross-clamping. Changes in speech or motor function indicate inadequate perfusion and the need for immediate bypass. Regional anaesthesia has therefore been regarded as the method of choice in this kind of surgery. METHODS: Seventy-five ASA I-III patients, scheduled for carotid endarterectomy, were randomly allocated to two groups to receive a combined cervical plexus block with two different techniques: according to either Winnie or to Moore. The quality of anaesthesia was compared using the Verbal Numeric Rating Score (VNRS) and the Visual Analogue Score (VAS). RESULTS: Both methods were safe and provided fair analgesia, with similar patient satisfaction and minimal cardiovascular side effects. Serious cerebral ischaemia requiring temporary bypass occurred in three cases. Additional local infiltration was necessary in both groups. CONCLUSION: The cervical plexus block, regardless of the technique used, provides high satisfaction and safety during cervical endarterectomy.