General Combined Anesthesia in Combination with Superficial Cervical Plexus Block during Carotid Artery Surgery

Abstract

Objective: to reduce the amount of anesthetics and analgesics during carotid artery surgery, by combining general anesthesia and superficial cervical plexus block. Materials and methods. The study included 33 operations on the carotid arteries. Group 1 covered 17 operations for which a combination of propofol and fentanyl was used for anesthesia. Group 2 comprised 16 operations for which, in addition to propofol and fentanyl, superficial cervical plexus block with bupivacaine solution was carried out. At surgery the authors estimated hemodynamic parameters, plasma cortisol levels, the number of intra- and postoperative complications, and morbidity rates. The intensity of pain syndrome and the amount of analgesics were assessed within the first 20—24 hours after surgery. Results. During anesthesia, Group 2 children needed a lower amount of propofol and fentanyl to maintain anesthesia, shorter mechanical ventilation and earlier extubation than did Group 1 patients. At surgery, Group 2 patients showed a significantly reduced hemodynamic response to skin incision and lower plasma cortisol levels when the carotid artery was exposed. Postoperatively, Group 2 patients had a lower intensity of pain syndrome than Group 1 patients. Conclusion. As compared with general anesthesia, the anesthesia based on propofol and fentanyl in combination with superficial cervical plexus block using bupivacaine solution provides optimal intraoperative patient protection and improves analgesia within the first 24 hours after surgery.