Advertisement

Ultrasound-guided intermediate cervical plexus and additional peripheral facial nerve block for carotid endarterectomy

A prospective pilot study

Ultraschallgesteuerte intermediäre zervikale Plexusblockade und Block des N. facialis zur Karotisendarteriektomie

Eine prospektive Pilotstudie

  • 1324 Accesses

  • 1 Citations

Abstract

Background and objectives

Ultrasound-guided intermediate cervical plexus block with perivascular local anesthetic infiltration is an established anesthetic procedure for carotid endarterectomy. In this prospective pilot study an additional subplatysmal block of the superficial ansa cervicalis is presented for the first time. The target structures are the anastomoses between the facial nerve (cervical and marginal mandibular branches) and cervical plexus.

Methods

An ultrasound-guided intermediate cervical plexus block (20 ml of ropivacaine 0.75%) was performed (n = 28). Then, depending on the individual sonoanatomy, 5 ml of prilocaine 1% was injected into the carotid sheath (group 1: no perivascular infiltration, n = 14, group 2: perivascular infiltration, n = 14). The third step was subplatysmal injection of 5 ml of prilocaine 1% between the medial edge of the sternocleidomastoid muscle and the submandibular gland (n = 28). The investigated parameters included the need for supplementation and block-related side effects.

Results

The requirement for supplemental local anesthetic infiltration in the skin incision area was minimal at mean (M) 1.1 ml (standard deviation (SD) ±2.4 ml). Perivascular infiltration in group 2 significantly decreased the total amount of local anesthetic supplemented: group 1 M = 4.2 ml (SD = ±3.1 ml), group 2 M = 1.7 ml (SD = ±2.0 ml) (p = 0.018). The incidence of block-related side effects was not significantly different between the two groups.

Conclusion

This study presents an ultrasound-guided subplatysmal block of the superficial ansa cervicalis for the first time, with the aim of optimizing anesthesia quality during surgical interventions in the carotid triangle.

Zusammenfassung

Hintergrund und Ziele

Die ultraschallgesteuerte intermediäre zervikale Plexusblockade mit perivaskulärer lokaler Anästhetikainfiltration ist ein etabliertes Anästhesieverfahren für offen-chirurgische Karotisendarteriektomien. In dieser prospektiven Pilotstudie wird erstmals ein zusätzlicher subplatysmaler Block der Ansa cervicalis superficialis vorgestellt. Zielstrukturen sind Anastomosen zwischen dem N. facialis (Rr. colli und marginalis mandibulae) und dem Plexus cervicalis.

Material und Methoden

In beiden Gruppen wurde ultraschallgesteuert eine intermediäre zervikale Plexusblockade (20 ml 0,75 %iges Ropivacain) durchgeführt (n = 28). Eine perivaskuläre Infiltration (5 ml 1 %iges Prilocain) erfolgte in Abhängigkeit von der individuellen Sonoanatomie (Gruppe 1 (n = 14) ohne, Gruppe 2 (n = 14) mit perivaskulärer Infiltration). Der dritte Schritt war die subplatysmale Injektion von 5 ml 1 %igem Prilocain zwischen dem medialen Rand des Kopfwenders und der Unterkieferspeicheldrüse (n = 28). Die untersuchten Parameter umfassten den Bedarf an Supplementierung durch den Operateur (1 %iges Prilocain) sowie blockadebedingte Nebenwirkungen.

Ergebnisse

Der Bedarf an zusätzlicher lokaler Infiltration durch den Operateur im Bereich der Hautinzision war minimal: Mittelwert (M) 1,1 ml (Standardabweichung (SD) ±2,4 ml) 1 %iges Prilocain. Das Einsetzen eines retromandibulären Retraktors war zudem in allen Fällen schmerzfrei möglich. Eine zusätzliche perivaskuläre Infiltration (Gruppe 2) verringerte signifikant den Bedarf an Supplementierung durch den Chirurgen: Gruppe 1 M = 4,2 ml (SD = ±3,1 ml), Gruppe 2 M = 1,7 ml (SD = ±2,0 ml) 1 %iges Prilocain (p = 0,018). Die Inzidenz blockadebedingter Nebenwirkungen zeigte keine signifikanten Gruppenunterschiede.

Fazit

In dieser prospektiven Pilotstudie wurde die zervikale Plexusblockade erstmals durch einen ultraschallgesteuerten subplatysmalen Block der Ansa cervicalis superficialis ergänzt. Ziel war die Verbesserung der Anästhesiequalität bei operativen Karotisdesobliterationen.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Adjuk M, Tudorić I, Šarlija M et al (2011) Effect of carotid sinus nerve blockade on hemodynamic stability during carotid endarterectomy under local anesthesia. J Vasc Surg 54:386–393

  2. 2.

    Barone M, Diemunsch P, Baldassare E et al (2010) Carotid endarterectomy with intermediate cervical plexus block. Tex Heart Inst J 37:297–300

  3. 3.

    Calderon AL, Zetlaoui P, Benatir F et al (2015) Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study. Anaesthesia 70:445–451

  4. 4.

    Casutt M, Breitenmoser I, Lennart W et al (2015) Ultrasound-guided carotid sheath block for carotid endarterectomy: a case series of the spread of injectate. Heart Lung Vessel 7:168–176

  5. 5.

    Choquet O, Dadure C, Cabdevila X (2010) Ultrasound-guided deep or intermediate cervical plexus block: the target should be the posterior cervical space. Anesth Analg 111:1563–1564

  6. 6.

    Feigl GC, Rosmarin W, Likar R (2006) Block of the superior cervical ganglion of the Truncus sympathicus. Why it often is not possible? Schmerz 20:203–208

  7. 7.

    Feigl GC, Rosmarin W, Stelzl A et al (2007) Comparison of different injectate volumes for stellate ganglion block: an anatomic and radiologic study. Reg Anesth Pain Med 32:203–208

  8. 8.

    Hong MJ, Baek H, Kim DY et al (2016) Spinal accessory nerve: ultrasound findings and correlations with neck lymph node levels. Ultraschall Med 37:487–491

  9. 9.

    Koköfer A, Namratil J, Felder TK et al (2015) Ropivacaine 0.375 % vs. 0.75 % with prilocaine for intermediate cervical plexus block for carotid endarterectomy: a randomised trial. Eur J Anaesthesiol 32:781–789

  10. 10.

    von Lanz T, Wachsmuth W (2004) Hals. In: von Lanz T, Wachsmuth W (eds) Praktische Anatomie. Ein Lehr- und Hilfsbuch der anatomischen Grundlagen ärztlichen Handelns. Springer, Berlin, pp 12–22

  11. 11.

    Litz R, Avila Gonzalez C, Feigl G (2016) Cervical plexus block. In: Karmakar MJ et al (ed) Musculoskeletal ultrasound for regional anaesthesia and pain medicine, 2nd edn. The Chinese University of Hongkong, Hongkong, pp 253–265

  12. 12.

    Martusevicius R, Swiatek F, Joergensen LG et al (2012) Ultrasound-guided locoregional anaesthesia for carotid endarterectomy: a prospective observational study. Eur J Vasc Endovasc Surg 44:27–30

  13. 13.

    Pandit JJ, Bree S, Dillon P et al (2000) A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. Anesth Analg 91:781–786

  14. 14.

    Pandit JJ, Satya-Krishna R, Gration P (2007) Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 99:159–169

  15. 15.

    Ramachandran SK, Picton P, Shanks A et al (2011) Comparison of intermediate vs subcutaneous cervical plexus block for carotid endarterectomy. Br J Anaesth 107:157–163

  16. 16.

    Rössel T, Kersting S, Heller AR et al (2013) Combination of high-resolution ultrasound-guided perivascular regional anesthesia of the internal carotid artery and intermediate cervical plexus block for carotid surgery. Ultrasound Med Biol 39:981–986

  17. 17.

    Seidel R (2018) Cervical plexus block. In: Gray AT (ed) Atlas of ultrasound-guided regional anesthesia, 3rd edn. Elsevier, Philadelphia, pp 372–380

  18. 18.

    Seidel R, Schulze M, Zukowski K et al (2015) Ultraschallgesteuerte intermediäre zervikale Plexusanästhesie. Anatomische Untersuchung. Anaesthesist 64:446–450

  19. 19.

    Seidel R, Zukowski K, Wree A et al (2016) Ultrasound-guided intermediate cervical plexus block and perivascular local anesthetic infiltration for carotid endarterectomy: a randomized controlled trial. Anaesthesist 65:917–924

  20. 20.

    Shoja MM, Oyesiku NM, Griessenauer CJ et al (2014) Anastomoses between lower cranial and upper cervical nerves: a comprehensive review with potential significance during skull base and neck operations, part I: trigeminal, facial and vestibulocochlear nerves. Clin Anat 27:118–113

  21. 21.

    Shoja MM, Oyesiku NM, Shokouhi G et al (2014) Anastomoses between lower cranial and upper cervical nerves: a comprehensive review with potential significance during skull base and neck operations, part II: glossopharyngeal, vagus, accessory, hypoglossal and cervical spinal nerves 1–4. Clin Anat 27:131–144

Download references

Funding

The study was conducted with financial support from the HELIOS Research Centre, Berlin, Germany (ID 056238).

Contribution of authors

R. Seidel designed and conducted the study, analyzed the data and wrote the manuscript. K. Zukowski conducted the study and revised the manuscript critically for intellectual content. A. Wree revised the manuscript critically for intellectual content. M. Schulze performed the anatomical preparations and revised the manuscript critically for intellectual content.

Author information

Correspondence to R. Seidel MD.

Ethics declarations

Conflict of interest

R. Seidel, K. Zukowski, A. Wree and M. Schulze declare that they have no competing interests.

All studies on humans described in the manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration from 1975 (in its current revised form). Informed consent was obtained from all patients included in the studies.

Caption Electronic Supplementary Material

ESM1_Video 1: Block of the superficial cervical ansa—sonoanatomic landmarks

ESM2_Video 2: Block of the superficial cervical ansa—injection of local anesthetic

ESM1_Video 1: Block of the superficial cervical ansa—sonoanatomic landmarks

ESM2_Video 2: Block of the superficial cervical ansa—injection of local anesthetic

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Seidel, R., Zukowski, K., Wree, A. et al. Ultrasound-guided intermediate cervical plexus and additional peripheral facial nerve block for carotid endarterectomy. Anaesthesist 67, 907–913 (2018) doi:10.1007/s00101-018-0493-7

Download citation

Keywords

  • Internal carotid artery stenosis
  • Vagus nerve
  • Anesthesia, regional
  • Ultrasonography
  • Facial nerve

Schlüsselwörter

  • Karotisstenose
  • N. Vagus
  • Regionalanästhesie
  • Sonogaphie
  • N. facialis