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Combination of High-Resolution Ultrasound-Guided Perivascular Regional Anesthesia of the Internal Carotid Artery and Intermediate Cervical Plexus Block for Carotid Surgery.
MedLine Citation:
PMID:  23499343     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
All previously documented regional anesthesia procedures for carotid artery surgery routinely require additional local infiltration or systemic supplementation with opioids to achieve satisfactory analgesia because of the complex innervation of the surgical site. Here, we report a reliable ultrasound-guided anesthesia method for carotid artery surgery. High-resolution ultrasound-guided regional anesthesia using a 12.5-MHz linear ultrasound transducer was performed in 34 patients undergoing carotid endarterectomy. Anesthesia consisted of perivascular regional anesthesia of the internal carotid artery and intermediate cervical plexus block. The internal carotid artery and the nerves of the superficial cervical plexus were identified, and a needle was placed dorsal to the internal carotid artery and directed cranially to the carotid bifurcation under ultrasound visualization. After careful aspiration, local anesthetic was spread around the internal carotid artery and the carotid bifurcation. In the second step, local anesthetic was injected below the sternocleidomastoid muscle along the previously identified nerves of the intermediate cervical plexus. The necessity for intra-operative supplementation and the conversion rate to general anesthesia were recorded. Ultrasonic visualization of the region of interest was possible in all cases. Needle direction was successful in all cases. Three to five milliliters of 0.5% ropivacaine produced satisfactory spread around the carotid bifurcation. For intermediate cervical plexus block, 10 to 20 mL of 0.5% ropivacaine produced sufficient intra-operative analgesia. Conversion to general anesthesia because of an incomplete block was not necessary. Five cases required additional local infiltration with 1% prilocaine (2-6 mL) by the surgeon. Visualization with high-resolution ultrasound yields safe and accurate performance of the block. Because of the low rate of intra-operative supplementation, we conclude that the described ultrasound-guided perivascular anesthesia technique is effective for carotid artery surgery.
Authors:
Thomas Rössel; Stephan Kersting; Axel R Heller; Thea Koch
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-3-14
Journal Detail:
Title:  Ultrasound in medicine & biology     Volume:  -     ISSN:  1879-291X     ISO Abbreviation:  Ultrasound Med Biol     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-3-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0410553     Medline TA:  Ultrasound Med Biol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. Electronic address: thomas.roessel@uniklinikum-dresden.de.
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