1
|
Adamczyk K, Koszela K, Zaczyński A, Niedźwiecki M, Brzozowska-Mańkowska S, Gasik R. Ultrasound-Guided Blocks for Spine Surgery: Part 1-Cervix. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2098. [PMID: 36767465 PMCID: PMC9915556 DOI: 10.3390/ijerph20032098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.
Collapse
Affiliation(s)
- Kamil Adamczyk
- Department of Anaesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Kamil Koszela
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Artur Zaczyński
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Marcin Niedźwiecki
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Sybilla Brzozowska-Mańkowska
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Robert Gasik
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| |
Collapse
|
2
|
Uhlig C, Vicent O, Spieth S, Ludwig S, Reeps C, Heller AR, Thea K, Spieth PM, Rössel T. Influence of Anatomic Conditions on Efficacy and Safety of Combined Intermediate Cervical Plexus Block and Perivascular Infiltration of Internal Carotid Artery in Carotid Endarterectomy: A Prospective Observational Trial. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2890-2902. [PMID: 34325958 DOI: 10.1016/j.ultrasmedbio.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound-guided intermediate cervical plexus blockade with perivascular infiltration of the carotid artery bifurcation perivacular block (PVB) is a reliable technique for regional anesthesia in carotid endarterectomy (CEA). We investigated the effect of the carotid bifurcation level (CBL) on PVB efficacy and safety in patients undergoing CEA. This prospective observational cohort study included 447 consecutive CEA patients who received PVB over a 6-y period. Vascular and neurologic puncture-related complications were recorded. The CBL was localized at the low level (C4 and C5 vertebra, low-level [LL] group) in 381 (85.2%) patients and at the high level (C2 and C3 vertebra, high-level [HL] group) in 66 (14.8%) patients. Local anesthetic supplementation by surgeons was necessary in 64 (14.3%) patients in the LL group and 38 (59.4%) patients in the HL group (p < 0.001) and was associated with a higher rate of central neurologic complications in the HL group (p = 0.031). Therefore, the efficacy of the PVB may be influenced by the CBL.
Collapse
Affiliation(s)
- Christopher Uhlig
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Oliver Vicent
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Spieth
- Department of Radiology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ludwig
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Axel R Heller
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Koch Thea
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| |
Collapse
|
3
|
[Regional anesthesia for carotid surgery : An overview of anatomy, techniques and their clinical relevance]. Anaesthesist 2017; 66:283-290. [PMID: 28188324 DOI: 10.1007/s00101-017-0270-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perioperative care for patients undergoing carotid endarterectomy (CEA) often presents a challenge to the anesthesia provider, as this patient group commonly suffers from a wide range of comorbidities. Although clinical trials could not demonstrate a significant benefit associated with regional anesthesia for outcomes such as insult, cardiac infarction or mortality, many authors concur that regional anesthetic techniques might be preferential in specific patient populations for this type of surgery. OBJECTIVES This article aims to present an overview of the currently used techniques for regional anesthesia in CEA, as well as discussing their influence on the perioperative outcome. MATERIALS AND METHODS After performing an extensive search of medical databases (Pubmed/Medline) the authors present a narrative analysis and interpretation of recent literature. RESULTS Currently there is a clear trend towards ultrasound guided regional anesthesia and away from classic landmark based techniques. The literature seems to support the notion that superior and intermediate cervical blocks are safer and less invasive than deep blocks. CONCLUSIONS With regional anesthetic techniques evolving to be more and more complex, the use of ultrasound is becoming increasingly indispensable in the operating theatre. For anesthesiologists with sufficient training and a profound knowledge of the respective anatomy, regional anesthesia seems to be a veritable alternative to general anesthesia for CEA.
Collapse
|
4
|
Ropivacaine 0.375% vs. 0.75% with prilocaine for intermediate cervical plexus block for carotid endarterectomy: A randomised trial. Eur J Anaesthesiol 2016; 32:781-9. [PMID: 25782662 DOI: 10.1097/eja.0000000000000243] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carotid endarterectomy is widely performed under regional anaesthesia. Ultrasound guidance is increasingly used in many regional anaesthetic procedures to improve safety and efficacy, and because it can reduce the amount of local anaesthetic required. Despite this, an ideal approach and dosing regimen for cervical plexus block remain elusive. OBJECTIVE The aim of this study was to compare two different concentrations of ropivacaine in terms of analgesic adequacy, haemodynamic effects and plasma concentration using an ultrasound-guided triple approach for intermediate cervical plexus blockade. DESIGN A randomised, placebo-controlled, blinded study. SETTING University Clinic Salzburg, Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria, from 16 November 2012 to 17 September 2013. PATIENTS Forty-six patients prospectively randomised to receive ultrasound-guided intermediate cervical block with either 20 ml ropivacaine 0.75% or 20 ml ropivacaine 0.375% each with 20 ml prilocaine 1%. INTERVENTION After subcutaneous infiltration, blocks were performed using ultrasound-guided infiltration below the sternocleidomastoid muscle, and ultrasound-guided infiltration of the carotid sheath. Ropivacaine and prilocaine plasma concentrations were measured at intervals. MAIN OUTCOME The primary study endpoint was the volume of supplementary lidocaine 1% required to achieve adequate surgical anaesthesia. Perioperative haemodynamic variables and pain scores were recorded. RESULTS There was no statistical difference in the volume of supplementary lidocaine given: 5.0 (±3.63) ml in the ropivacaine 0.375% group and 5.17 (±2.76) ml in the ropivacaine 0.75% group (P = 0.846). Pain scores were similarly low across both groups. Measured concentrations of ropivacaine and prilocaine did not reach toxic levels in either group. Levels of ropivacaine were approximately two-fold higher in the 0.75% group [mean area under the curve (AUC) 10 531.11 (±2912.84) vs. 5264.34 ng (±1594.69), P < 0.0001]. Perioperative cardiovascular stability was excellent in both groups. There were no serious block-related complications. CONCLUSION An ultrasound-guided intermediate block provides adequate anaesthesia for carotid thrombendarterectomy with a little need for supplementary local anaesthetic. Use of 0.375% ropivacaine provided similarly effective analgesia as 0.75%, but resulted in significantly lower plasma concentrations. TRIAL REGISTRATION The study was registered at the European Clinical Trial Database (Eudra CT No.: 2012-002769) as well as at ClinicalTrials.gov (NCT01759940).
Collapse
|
5
|
Abstract
Summary Regional anaesthesia is a popular choice for patients undergoing carotid endarterectomy (CEA). Neurological function is easily assessed during carotid cross-clamping; haemodynamic control is predictable; and hospital stay is consistently shorter compared with general anaesthesia (GA). Despite these purported benefits, mortality and stroke rates associated with CEA remain around 5% for both regional anaesthesia and GA. Regional anaesthetic techniques for CEA have improved with improved methods of location of peripheral nerves including nerve stimulators and ultrasound together with a modification in the classification of cervical plexus blocks. There have also been improvements in local anaesthetic, sedative, and arterial pressure-controlling drugs in patients undergoing CEA, together with advances in the management of patients who develop neurological deficit after carotid cross-clamping. In the UK, published national guidelines now require the time between the patient's presenting neurological event and definitive treatment to 1 week or less. This has implications for the ability of vascular centres to provide specialized vascular anaesthetists familiar with regional anaesthetic techniques for CEA. Providing effective regional anaesthesia for CEA is an important component in the armamentarium of techniques for the vascular anaesthetist in 2014.
Collapse
Affiliation(s)
- M D Stoneham
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - D Stamou
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - J Mason
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| |
Collapse
|
6
|
Ciccozzi A, Angeletti C, Guetti C, Pergolizzi J, Angeletti PM, Mariani R, Marinangeli F. Regional anaesthesia techniques for carotid surgery: the state of art. J Ultrasound 2014; 17:175-83. [PMID: 25177390 DOI: 10.1007/s40477-014-0094-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This review will analyse some aspects of regional anaesthesia (RA) for carotid endarterectomy (CEA), a surgical procedure which requires a strict monitoring of patient's status. RA remains an important tool for the anaesthesiologist. Some debates remain about type and definition of regional anaesthesia, efficacy and safety of the different cervical block techniques, the right dose, concentration and volume of local anaesthetic, the use of adjuvants, the new perspectives: ultrasonography, the future directions. METHODS A literature search was performed for journal articles in English language in the PubMed Embase and in The Cochrane Library database, from January 2000 to December 2013. The electronic search strategy contained the following medical subject headings and free text terms: local anaesthesia versus general anaesthesia for endarterectomy, superficial and deep cervical block, complications of cervical nerve block, ultrasound guidance of superficial and deep cervical plexus block. CONCLUSIONS The gold standard for RA will be achieved after overcoming a number of limitations by a more extensive use of ultrasonography, by combining general and regional anaesthesia, including conscious anaesthesia, by defining the appropriate volume, concentration and dosage of local agents and by addition of adjuvants.
Collapse
Affiliation(s)
- Alessandra Ciccozzi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Chiara Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Cristiana Guetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Joseph Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA ; Department of Anesthesiology, Georgetown University School of Medicine, Washington D.C, USA ; Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA USA ; Association of Chronic Pain Patients, Houston, TX USA
| | - Paolo Matteo Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Roberta Mariani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| |
Collapse
|
7
|
Rössel T, Kersting S, Heller AR, Koch T. Combination of high-resolution ultrasound-guided perivascular regional anesthesia of the internal carotid artery and intermediate cervical plexus block for carotid surgery. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:981-986. [PMID: 23499343 DOI: 10.1016/j.ultrasmedbio.2013.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/10/2012] [Accepted: 01/09/2013] [Indexed: 06/01/2023]
Abstract
All previously documented regional anesthesia procedures for carotid artery surgery routinely require additional local infiltration or systemic supplementation with opioids to achieve satisfactory analgesia because of the complex innervation of the surgical site. Here, we report a reliable ultrasound-guided anesthesia method for carotid artery surgery. High-resolution ultrasound-guided regional anesthesia using a 12.5-MHz linear ultrasound transducer was performed in 34 patients undergoing carotid endarterectomy. Anesthesia consisted of perivascular regional anesthesia of the internal carotid artery and intermediate cervical plexus block. The internal carotid artery and the nerves of the superficial cervical plexus were identified, and a needle was placed dorsal to the internal carotid artery and directed cranially to the carotid bifurcation under ultrasound visualization. After careful aspiration, local anesthetic was spread around the internal carotid artery and the carotid bifurcation. In the second step, local anesthetic was injected below the sternocleidomastoid muscle along the previously identified nerves of the intermediate cervical plexus. The necessity for intra-operative supplementation and the conversion rate to general anesthesia were recorded. Ultrasonic visualization of the region of interest was possible in all cases. Needle direction was successful in all cases. Three to five milliliters of 0.5% ropivacaine produced satisfactory spread around the carotid bifurcation. For intermediate cervical plexus block, 10 to 20 mL of 0.5% ropivacaine produced sufficient intra-operative analgesia. Conversion to general anesthesia because of an incomplete block was not necessary. Five cases required additional local infiltration with 1% prilocaine (2-6 mL) by the surgeon. Visualization with high-resolution ultrasound yields safe and accurate performance of the block. Because of the low rate of intra-operative supplementation, we conclude that the described ultrasound-guided perivascular anesthesia technique is effective for carotid artery surgery.
Collapse
Affiliation(s)
- Thomas Rössel
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
| | | | | | | |
Collapse
|
8
|
Caruso B, Sánchez JM, García DA, de Paula E, Perillo MA. Probing the combined effect of flunitrazepam and lidocaine on the stability and organization of bilayer lipid membranes. A differential scanning calorimetry and dynamic light scattering study. Cell Biochem Biophys 2012; 66:461-75. [PMID: 23269502 DOI: 10.1007/s12013-012-9494-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Combined effects of flunitrazepam (FNZ) and lidocaine (LDC) were studied on the thermotropic equilibrium of dipalmitoyl phosphatidylcholine (dpPC) bilayers. This adds a thermodynamic dimension to previously reported geometric analysis in the erythrocyte model. LDC decreased the enthalpy and temperature for dpPC pre- and main-transitions (ΔHp, ΔHm, Tp, Tm) and decreased the cooperativity of the main-transition (ΔT(1/2,m)). FNZ decreased ΔHm and, at least up to 59 μM, also decreased ΔHp. In conjunction with LDC, FNZ induced a recovery of ∆T(1/2,m) control values and increased ΔHm even above the control level. The deconvolution of the main-transition peak at high LDC concentrations revealed three components possibly represented by: a self-segregated fraction of pure dpPC, a dpPC-LDC mixture and a phase with a lipid structure of intermediate stability associated with LDC self-aggregation within the lipid phase. Some LDC effects on thermodynamic parameters were reverted at proper LDC/FNZ molar ratios, suggesting that FNZ restricts the maximal availability of the LDC partitioned into the lipid phase. Thus, beyond its complexity, the lipid-LDC mixture can be rationalized as an equilibrium of coexisting phases which gains homogeneity in the presence of FNZ. This work stresses the relevance of nonspecific drug-membrane binding on LDC-FNZ pharmacological interactions and would have pharmaceutical applications in liposomal multidrug-delivery.
Collapse
Affiliation(s)
- Benjamín Caruso
- Departamento de Química, FCEFyN, Instituto de Investigaciones Biológicas y Tecnológicas (IIBYT), CONICET-Universidad Nacional de Córdoba, Córdoba, Argentina.
| | | | | | | | | |
Collapse
|
9
|
Bloc S, Rontes O, Mercadal L, Delbos A. Low Approach to Interscalene Brachial Plexus Block. Anesth Analg 2011; 113:1282; author reply 1282-3. [DOI: 10.1213/ane.0b013e318230409a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Cervical Plexus Block. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
11
|
Sindjelic RP, Vlajkovic GP, Davidovic LB, Markovic DZ, Markovic MD. The addition of fentanyl to local anesthetics affects the quality and duration of cervical plexus block: a randomized, controlled trial. Anesth Analg 2010; 111:234-7. [PMID: 20519423 DOI: 10.1213/ane.0b013e3181e1e9ab] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cervical plexus block is frequently associated with unsatisfactory sensory blockade. In this randomized, double-blind, placebo-controlled trial, we examined whether the addition of fentanyl to local anesthetics improves the quality of cervical plexus block in patients undergoing carotid endarterectomy (CEA). METHODS Seventy-seven consecutive adult patients scheduled for elective CEA were randomized to receive either fentanyl 1 mL (50 microg) or saline placebo 1 mL in a mixture of 10 mL bupivacaine 0.5% and 4 mL lidocaine 2% for deep cervical plexus block. Superficial cervical plexus block was performed using a mixture of 10 mL bupivacaine 0.5% and 5 mL lidocaine 2%. Pain was assessed using the verbal rating scale (0-10; 0 = no pain, 10 = worst pain imaginable), and propofol in 20-mg IV bolus doses was given to patients reporting verbal rating scale >3 during the procedure. Rescue medication consumption during surgery and analgesia requirements over the next 24 hours, as well as onset of sensory blockade, were recorded. A P value <0.05 was regarded as statistically significant. RESULTS Fewer patients in the fentanyl group (4 of 38, 10.5%) required propofol compared with the placebo group (26 of 39, 66.7%; P < 0.001). In comparison with the placebo group, the fentanyl group consumed less propofol (median 0 [0-60] vs 60 [0-160] mg, respectively; P < 0.001), required postoperative analgesia less frequently (22 of 38 patients, 57.9% vs 35 of 39 patients, 89.7%, respectively; P = 0.002), and requested the first analgesic after surgery later (median 5.8 [1.9-15.6] vs 3.1 [1.0-11.7] hours, respectively; P < 0.001), whereas the onset time of sensory blockade was similar in both groups (median 12 [9-18] vs 15 [9-18] minutes, respectively; P = 0.18). CONCLUSIONS The addition of fentanyl to local anesthetics improved the quality and prolonged the duration of cervical plexus block in patients undergoing CEA.
Collapse
Affiliation(s)
- Radomir P Sindjelic
- Institute of Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade University Medical School, Dr. Koste Todorovica 8, 11000 Belgrade, Serbia
| | | | | | | | | |
Collapse
|
12
|
Soeding P, Eizenberg N. Review article: anatomical considerations for ultrasound guidance for regional anesthesia of the neck and upper limb. Can J Anaesth 2009; 56:518-33. [DOI: 10.1007/s12630-009-9109-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 03/24/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022] Open
|
13
|
Bilateral guided cervical block for Zenker diverticulum excision in a patient with ankylosing spondylitis. J Anesth 2009; 23:143-6. [PMID: 19234842 DOI: 10.1007/s00540-008-0699-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
Patients with severe ankylosing spondylitis (AS) have difficulties in tracheal intubation. An 87-year-old man with severe AS was scheduled for Zenker diverticulum (ZD) excision. It was decided to proceed with combined bilateral cervical plexus blockade using a nerve stimulator. The surgery lasted about 3 h, with stable hemodynamics, ECG, and oxygen saturation. The use of a nerve stimulator-guided cervical block minimizes the risk of severe respiratory and/or airway compromise secondary to phrenic nerve or recurrent laryngeal nerve palsy, because it can elicit diaphragmatic muscle response, which helps to avoid the administration of local anesthetic directly to the area of the phrenic nerve, and guides correct needle placement. In conclusion, the nerve stimulatorguided bilateral cervical block in our ZD patient with AS was shown to be a safe and successful alternative anesthetic option.
Collapse
|
14
|
Pintaric TS, Kozelj G, Stanovnik L, Casati A, Hocevar M, Jankovic VN. Pharmacokinetics of levobupivacaine 0.5% after superficial or combined (deep and superficial) cervical plexus block in patients undergoing minimally invasive parathyroidectomy. J Clin Anesth 2009; 20:333-337. [PMID: 18761239 DOI: 10.1016/j.jclinane.2008.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Revised: 12/25/2007] [Accepted: 01/03/2008] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To evaluate the pharmacokinetic profile of 0.35 mL/kg of 0.5% levobupivacaine during superficial and combined (deep and superficial) cervical plexus block (CPB) in patients undergoing minimally invasive parathyroidectomy. DESIGN Prospective randomized study. SETTING Operating theater of a university hospital. PATIENTS 12 ASA physical status II and III patients (11 women and 1 man), scheduled for minimally invasive parathyroidectomy. INTERVENTIONS Seven and 5 patients were randomly assigned to receive either superficial or combined CPB, respectively. The superficial CPB was performed with an injection of 0.35 mL/kg of 0.5% levobupivacaine subcutaneously along the posterior border of the sternocleidomastoid muscle and deeper on its medial surface. The combined CPB was initiated by the deep block at the C3 level vertebra by injecting 0.2 mL/kg of 0.5% levobupivacaine, followed by the superficial block with an injection of the remaining 0.15 mL/kg. After completion of the block, venous blood was sampled at the intervals of 5, 10, 15, 20, 30, 45, and 60 minutes. MEASUREMENTS AND MAIN RESULTS Venous plasma concentrations were measured using gas chromatography-mass spectroscopy. Mean +/- SD of maximal concentrations of levobupivacaine was 0.58 +/- 0.41 mg/L in group superficial and 0.52 +/- 0.28 mg/L in group combined (P = 0.71). The median (range) time required to reach the maximal concentrations was 30 minutes (20-30 min) in group superficial and 20 minutes (15-30 min) in group combined (P = 0.45). The areas under the drug concentration/time curve (AUC(10-60)) were also similar in both groups. No signs of central nervous system or cardiovascular toxicity or other untoward events were observed in any patient. CONCLUSION With the given dose regimen, levobupivacaine plasma concentrations were within safe ranges.
Collapse
Affiliation(s)
| | - Gordana Kozelj
- Institute of Forensic Medicine, Medical Faculty of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Lovro Stanovnik
- Institute of Pharmacology and Experimental Toxicology, Medical Faculty of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Andrea Casati
- Department of Anesthesia, Medical Faculty, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Marko Hocevar
- Department of Surgery, Institute of Oncology, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Vesna Novak Jankovic
- Department of Anaesthesiology and Intensive Therapy, Clinical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
| |
Collapse
|
15
|
|
16
|
|
17
|
High-Resolution Ultrasound-Guided High Interscalene Plexus Block for Carotid Endarterectomy. Reg Anesth Pain Med 2007. [DOI: 10.1097/00115550-200705000-00013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Demonstration of the Spread of Injectate With Deep Cervical Plexus Block. Reg Anesth Pain Med 2007. [DOI: 10.1097/00115550-200703000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Cervical Plexus Block. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
20
|
Aunac S, Carlier M, Singelyn F, De Kock M. The Analgesic Efficacy of Bilateral Combined Superficial and Deep Cervical Plexus Block Administered Before Thyroid Surgery Under General Anesthesia. Anesth Analg 2002. [DOI: 10.1213/00000539-200209000-00039] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
21
|
Junca A, Marret E, Goursot G, Mazoit X, Bonnet F. A Comparison of Ropivacaine and Bupivacaine for Cervical Plexus Block. Anesth Analg 2001. [DOI: 10.1213/00000539-200103000-00032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|