Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery
Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery
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DOI：
10.1097/00000542-199810000-00015
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发表时间：
1998-10-01
期刊：
影响因子：
8.8
通讯作者：
Stanley, JC
中科院分区：
文献类型：
--
作者：
Stoneham, MD;Doyle, AR;Stanley, JC
背景资料：颈动脉内膜切除术可在颈丛阻滞下进行，术中必要时由外科医生补充局部麻醉。然而，目前尚不清楚是深颈丛阻滞还是浅颈丛阻滞提供了最佳的手术条件或患者满意度。因此，作者比较了两个在患者接受颈动脉内膜切除术。方法：40例接受颈动脉内膜切除术随机接受无论是浅或深颈丛阻滞20 ml布比卡因，0.375%。结果进行统计分析，包括补充麻醉剂与利多卡因，1%，由外科医生，皮节受影响的块，感觉异常，在块放置，术后疼痛评分，和镇痛剂的需求。中位补充利多卡因需要量为6分钟。深度阻滞组为0.5 ~ 20 ml，（范围，0至20 ml），浅表阻滞组（P = 0.7323），深度阻滞组中报告阻滞放置期间感觉异常的患者需要较少的利多卡因补充（中位数，2;范围，0.5至20 ml）比9.5 ml（范围，6至15.5 ml）所需的那些谁没有经历感觉异常（P = 0.0113）。与浅表阻滞组患者相比，深部阻滞组患者在术后前24 h内不太可能需要镇痛（P = 0.047），而需要镇痛的患者在术后较晚接受镇痛（术后6.6 +/- 4.1 vs. 3.9 +/- 1.4 h; Student t检验，P = 0.02）。一个病人在每组表示不满technique.Conclusions：颈动脉内膜剥脱术可以令人满意地进行在浅表或深颈丛阻滞的位置没有差异方面的补充局部麻醉的要求，虽然这是由是否引起感觉异常的影响，在放置深阻滞。因此，临床医生决定使用一个组织块而不是另一个组织块时，无需基于术中条件或患者满意度假设一个组织块的任何优效性。
Background: Carotid endarterectomy may be performed under cervical plexus block with local anesthetic supplementation by the surgeon as necessary during surgery. It is unclear, however, whether deep or superficial cervical plexus block offers the best operating conditions or patient satisfaction. Therefore, the authors compared the two in patients undergoing carotid endarterectomy.Methods: Forty patients undergoing carotid endarterectomy were randomized to receive either a superficial or a deep cervical plexus block with 20 ml bupivacaine, 0.375%. Outcomes subjected to statistical analysis included supplemental anesthetic supplementation with lidocaine, 1%, by the surgeon, dermatomes affected by the block, paresthesia during block placement, postoperative pain scores, and analgesic requirements.Results: Median supplemental lidocaine requirements were 6 mi (range, 0.5 to 20 ml) in the deep block group and 6 ml (range, 0 to 20 ml) in the superficial block group (P = 0.7323), Patients in the deep block group who reported paresthesia during block placement required less lidocaine supplementation (median, 2; range, 0.5 to 20 ml) than the 9.5 ml (range, 6 to 15.5 ml) required by those who did not experience paresthesia (P = 0.0113). Compared with patients in the superficial block group, those in the deep block group were less likely to need analgesia in the first 24 h after operation (P = 0.047), and those who required analgesia received it later (6.6 +/- 4.1 vs. 3.9 +/- 1.4 h after operation; Student's t test, P = 0.02). One patient In each group expressed dissatisfaction with the technique.Conclusions: Carotid endarterectomy may be performed satisfactorily during superficial or deep cervical plexus block placement with no differences in terms of supplemental local anesthetic requirements, although this is influenced by whether paresthesia is elicited during placement of the deep block. Therefore, the clinician's decision to use one block rather than another need not be based on any assumed superiority of one block based on intraoperative conditions or patient satisfaction.