Ultrasound-guided carotid sheath block and superficial cervical plexus block combo improves analgesia after carotid endarterectomy: Study

Carotid artery stenosis contributes significantly to ischemic stroke, which is the second leading cause of death worldwide and places a significant strain on healthcare systems. Carotid endarterectomy (CEA) is recommended as the preferred treatment for asymptomatic carotid stenosis of 60% or more and for patients exhibiting symptoms within the previous two weeks. Recent research study compared the efficacy of a superficial cervical plexus block (SCB) alone versus a combination of SCB and an ultrasound (US)-guided carotid sheath block (CSB) for patients undergoing carotid endarterectomy (CEA) surgery. The primary objective of the study was to explore the length of the sensory block after combining SCB and CSB. The study involved 60 patients scheduled for nonemergency CEA surgery, with the Subject group (n=28) receiving US-guided CSB and SCB, and the Control group (n=31) receiving only an SCB. Both groups received a local anesthetic (LA) mixture comprising 0.5% levobupivacaine and 2% lidocaine.

Study Results

The results of the study revealed that the Subject group demonstrated a significantly accelerated onset of sensory block and an extended time to first analgesia compared to the Control group. The sensory block was also substantially extended in the Subject group. Postoperative pain within the first 12 hours was more recurrent in the Control group, and NLR showed minimal disparity between the groups. The combination of SCB and US-guided CSB effectively and safely extended postoperative analgesia for CEA surgery, with no significant difference in the occurrence of adverse complications between the groups.

Analgesic Effect Comparison

The study found that the combination of SCB and US-guided CSB resulted in an extended postoperative analgesic effect compared to SCB alone. The results also demonstrated superior block quality in the Subject group, as evidenced by an extended sensory block time, prolonged time to additional analgesia, and reduced overall need for analgesia as compared to the Control group.

Haemodynamic Stability and NLR Analysis

Moreover, the study assessed the haemodynamic stability of both groups and found no statistically significant differences between them. The study also investigated the neutrophil-to-lymphocyte ratio (NLR) as an indicator of stress associated with the performance of anesthesia, with the results showing no significant difference in NLR between the groups. In conclusion, the combination of SCB and US-guided CSB was effective in providing enhanced postoperative analgesia for patients undergoing CEA surgery. The study's findings suggest that the combination approach is a promising strategy for extending postoperative pain alleviation and improving the quality of analgesia in the postoperative recovery period for CEA surgery.

Key Points

- The study compared the efficacy of superficial cervical plexus block (SCB) alone versus a combination of SCB and ultrasound-guided carotid sheath block (CSB) for patients undergoing carotid endarterectomy (CEA) surgery. 60 patients scheduled for CEA surgery were divided into two groups, with the Subject group receiving US-guided CSB and SCB, and the Control group receiving only SCB. Both groups received a local anesthetic mixture.

- The results showed that the Subject group had a significantly accelerated onset of sensory block and an extended time to first analgesia compared to the Control group. Additionally, the Subject group demonstrated substantially extended sensory block, while postoperative pain within the first 12 hours was more recurrent in the Control group. However, there was minimal disparity in the Neutrophil-to-Lymphocyte Ratio (NLR) between the groups. The combination of SCB and US-guided CSB effectively extended postoperative analgesia for CEA surgery with no significant difference in adverse complications between the groups.

- The combination of SCB and US-guided CSB resulted in an extended postoperative analgesic effect compared to SCB alone. The Subject group showed superior block quality, with extended sensory block time, prolonged time to additional analgesia, and reduced overall need for analgesia compared to the Control group.

- The study found no statistically significant differences in haemodynamic stability between the two groups. Additionally, the neutrophil-to-lymphocyte ratio (NLR) as an indicator of stress associated with anesthesia showed no significant difference between the Subject and Control groups. - Overall, the combination of SCB and US-guided CSB effectively provided enhanced postoperative analgesia for patients undergoing CEA surgery, demonstrating promise in extending postoperative pain alleviation and improving the quality of analgesia in the postoperative recovery period for CEA surgery.

Reference -

Kruc A, Lijovic L, Skrtic M, Pazur I,  Perisa N, Radocaj T. Enhancing postoperative analgesia in carotid  endarterectomy patients: The potential of ultrasound‑guided carotid  sheath block combined with superficial cervical plexus block: A randomised trial. Indian J Anaesth 2024;68:801‑8.