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Cervical plexus anesthesia for carotid endarterectomy: comparison of ropivacaine and mepivacaine

Canadian Journal of Anaesthesia volume 47, pages 185–187 (2000)Cite this article

Abstract

Purpose: To evaluate the effectiveness of cervical plexus block performed with ropivacaine 0.75% or 1%, or mepivacaine 2%.

Methods: In a prospective, randomized, double-blind study, 60 patients received deep cervical plexus block with 0.2 ml·kg−1 divided among C2–C4 injections using ropivacaine 0.75% and 1% or mepivacaine 2%. A blinded observer recorded loss of pin-prick sensation every minute in the C2–C4 dermatomes until readiness for surgery. Then, a superficial cervical block was performed with 0.15 ml·kg−1 lidocaine 1%. The need for intraoperative supplemental analgesia and degree of pain and time of first postoperative pain medication were also recorded.

Results: General anesthesia was not required to complete surgery in any case. No differences in the need for intraoperative supplemental analgesia was observed (7, 6, and 9 patients with ropivacaine 0.75% and 1% or mepivacaine 2%, respectively). Readiness to surgery required 15 (10–25) min with ropivacaine 0.75%, 18 (8–20) min with ropivacaine 1%, and 15 (5–20) min with mepivacaine 2% (P=NS); while patients asked for first postoperative pain medication after 10 (4–13) hr and 9 (6.5–11) hr with ropivacaine 0.75% and 1% compared with 5 (0–8) hr with mepivacaine 2% (P<0.05).

Conclusion: Ropivacaine 0.75% or 1% are appropriate choices when performing cervical plexus anesthesia for carotid endarterectomy, providing nerve block characteristics similar to those of mepivacaine 2%, but with the advantage of longer postoperative pain relief.

Résumé

Objectif: Évaluer l’efficacité du blocage du plexus cervical réalisé avec de la ropivacaïne 0,75 % ou 1 %, ou de la mépivacaïne 2 %.

Méthode: Lors d’une étude prospective, randomisée et à double insu, 60 patients ont reçu un blocage profond du plexus cervical avec 0,2 ml·kg−1 divisé en injections C2–C4 de ropivacaïne 0,75 % et 1 % ou de mépivacaïne 2 %. Un observateur impartial a enregistré la perte de sensation à la piqûre à chaque minute dans les dermatomes de C2–C4 jusqu’à l’insensibilité nécessaire à l’opération. Un blocage cervical superficial a ensuite été réalisé avec 0,15 ml·kg−1 de lidocaïne 1 %. Les besoins d’analgésie d’appoint peropératoire et le degré de la douleur ainsi que le moment de la première demande postopératoire d’analgésique ont aussi été notés.

Résultats: Aucun patient n’a eu besoin d’anesthésie générale pendant l’intervention chirurgicale. Aucune différence d’analgésie supplémentaire peropératoire n’a été observée (7, 6, et 9 patients avec la ropivacaïne 0,75 % et 1 % ou la mépivacaïne 2 %, respectivement). Pour être prêt à l’opération, il a fallu 15 (10–25) min avec la ropivacaïne 0,75 %, 18 (8–20) min avec la ropivacaïne 1 %, et 15 (5–20) min avec la mépivacaïne 2 % (P=NS); les patients ont demandé une première dose d’analgésie postopératoire après 10 (4–13) h et 9 (6,5–11) h avec la ropivacaïne 0,75 % et 1 % en comparaison de 5 (0–8) h avec la mépivacaïne 2 % (P<0,05).

Conclusion: La ropivacaïne 0,75 % ou 1 % constitue un bon choix pour réaliser une anesthésie du plexus cervical lors d’une endartériectomie carotidienne, les caractéristiques du blocage nerveux étant similaires à celles de la mépivacaïne 2 %, mais comportant l’avantage d’un soulagement prolongé de la douleur postopératoire.

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Affiliations

  1. From the Department of Anaesthesiology, University of Milan, Milan, Italy

    Albino Leoni, Silvio Magrin, Giuseppe Mascotto, Andrea Rigamonti, Giorgio Gallioli, Fausto Muzzolon, Guido Fanelli & Andrea Casati

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  1. Albino Leoni
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  2. Silvio Magrin
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  3. Giuseppe Mascotto
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  4. Andrea Rigamonti
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  5. Giorgio Gallioli
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  6. Fausto Muzzolon
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  7. Guido Fanelli
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  8. Andrea Casati
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Correspondence to Andrea Casati.

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Leoni, A., Magrin, S., Mascotto, G. et al. Cervical plexus anesthesia for carotid endarterectomy: comparison of ropivacaine and mepivacaine. Can J Anaesth 47, 185–187 (2000). https://doi.org/10.1007/BF03018858

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Keywords

  • Ropivacaine
  • Carotid Endarterectomy
  • Mepivacaine
  • Cervical Plexus
  • Block Placement