Head and Neck: Superficial Cervical Plexus Block for Awake Carotid Endarterectomy

Abstract

Carotid endarterectomy (CEA) is a revascularization surgery performed to reduce the risk of stroke in patients with symptomatic carotid artery stenosis due to atherosclerosis. Peripheral nerve blocks utilized for CEA include superficial and deep cervical plexus block. Superficial cervical plexus block targets the lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves (sensory branches of nerve roots C2-C4). The deep cervical plexus block targets the spinal nerve roots C2-C4 at the level of the respective transverse process. Cervical plexus block for CEA offers the advantage of an awake patient during carotid cross-clamping, facilitating neurological assessment and early recognition of cerebral ischemia. Superficial cervical plexus block is safe and simple to perform, with low overall complication rate. Landmark technique targets the plexus halfway along the posterior border of the sternocleidomastoid muscle; an ultrasound-guided approach is also described.