Combined Cervical Plexus Block Research Articles

Anesthetic management of primary hyperparathyroidism during pregnancy

Rationale:Primary hyperparathyroidism (PHPT) during pregnancy is rare. Nevertheless, hypercalcemia secondary to gestational PHPT may be masked by physiological changes in calcium homeostasis during pregnancy. Gestational PHPT constitutes a serious danger to mother and fetus. Surgery is the only curative treatment when conservative treatment could not control the condition. Due to the lack of guidelines concerning PHPT during pregnancy, the optimal anesthetic management of PHPT during pregnancy needs to be individualized. Patient concerns: We report a case of PHPT with successful surgical treatment under combined cervical plexus block and general anesthesia.Diagnosis:She was diagnosed with hypercalcemia, PHPT, a possible parathyroid adenoma, and a 19-week intrauterine pregnancy.Interventions:The patient underwent heparin-free hemodialysis before the surgery in the nephrology department in the presence of a cardiologist. She then received a successful parathyroidectomy under combined bilateral superficial cervical plexus block and general anesthesia in her 19th week of pregnancy.Outcomes:She was released from the hospital with no maternal or fetal complications on postoperative day 9. A healthy baby boy was uneventfully born at 37 weeks of gestation.Lessons:We suggest that surgical removal of the lesion after lowering the blood calcium concentration in mid-pregnancy is currently the optimal treatment option for pregnant patients with PHPT. Furthermore, multidisciplinary perioperative management is particularly important.

Regional cervical plexus blockage for carotid endarterectomy in patients with cardiovascular risk factors.

Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

Effect evaluation of combined cervical plexus block with cervical vertibra drawing for cervical spondylotic radiculopathy

Objective To observe the effect of cervical plexus block combined with cervical vertebra traction treatment of cervical spondylosis of nerve root type .Methods 60 cases of nerve root type cervical spondylosis were divided into two groups by coin tossing：group A（n=32） cervical plexus block combined with cervical traction thera-py, group B（ n=28） treated by cervical traction therapy ,according to the severity of pain compared two groups of treatment effect.Results after treatment,20d group 10d,30d,90d pain scores were （4.61 ±0.70）%,（3.71 ± 0.57）%,（3.30 ±0.65）%,（4.44 ±1.04）%,group B respectively （5.88 ±1.47）%,（5.61 ±1.35）%,（4.83 ± 0.86）%,（5.50 ±0.87）%,the difference between two groups was statistically significant （t=5.85,1.06,1.30, 7.51,all P<0.01）.Conclusion The cervical plexus block combined with cervical traction for treatment of nerve root type of cervical spondylosis is better than the routine treatment of cervical traction ,which is suitable for promotion of primary health care units . Key words: Anesthesia; Traction; Cervical spondylosis

Pharmacokinetics of levobupivacaine 0.5% after superficial or combined (deep and superficial) cervical plexus block in patients undergoing minimally invasive parathyroidectomy

Study ObjectiveTo 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. DesignProspective randomized study. SettingOperating theater of a university hospital. Patients12 ASA physical status II and III patients (11 women and 1 man), scheduled for minimally invasive parathyroidectomy. InterventionsSeven 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 ResultsVenous 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 (AUC10-60) were also similar in both groups. No signs of central nervous system or cardiovascular toxicity or other untoward events were observed in any patient. ConclusionWith the given dose regimen, levobupivacaine plasma concentrations were within safe ranges.

Superficial vs combined cervical plexus block for carotid endarterectomy: a prospective, randomized study

Resumo Este estudo visa comparar o bloqueio cervical combinado e superficial em pacientes submetidos a endarterectomia de carótida (CEA) em relação à efetividade anestésica, satisfação do paciente e cirurgião, complicações decorrentes do tipo de anestesia, e evolução final. Foram estudados 125 pacientes submetidos a CEA eletiva. Esses pacientes foram randomizados em dois grupos: no primeiro grupo foi realizado o bloqueio cervical superficial, e no segundo grupo bloqueio cervical combinado (superficial mais profundo). Não houve diferença, estatisticamente significativa quanto a qualidade anestésica quando comparados os dois tipos de bloqueio. Em relação às complicações decorrentes da realização do bloqueio, no grupo do bloqueio superficial, apenas um (1,6%) paciente apresentou complicação decorrente do método anestésico, no grupo do bloqueio combinado, cinco (7,4%) pacientes apresentaram complicações relacionadas à anestesia ( P > .05). A complementação anestésica pelo cirurgião foi necessária em 50 pacientes (81,96%) sem diferença estatisticamente significante entre os dois grupos. As condições cirúrgicas foram muito semelhantes nos dois grupos, não havendo diferença estatisticamente significativa. A morbimortalidade final em nossa série foi de 1,6%. O bloqueio anestésico cervical superficial tem a mesma efetividade que o combinado. As condições cirúrgicas são muito semelhantes. A incidência de complicações relacionadas à técnica anestésica é maior no bloqueio combinado. O tipo de bloqueio não influiu na evolução final dos pacientes.

A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. (University of Michigan Medical Center, Ann Arbor, MI) Anesth Analg 2000;91:781–786.

Carotid endarterectomy may be preformed by using cervical plexus blockade with local anesthetic supplementation by the surgeon during surgery. Most practitioners use either a superficial cervical plexus block or a combined (superficial and deep) block, but it is unclear which offers the best operative conditions or greatest patient satisfaction. This study compared the 2 techniques in 40 patients undergoing carotid endarterectomy. The patient randomly received either a superficial or a combined cervical plexus block. Bupivacaine 0.375% to a total dose of 1.4 mg/kg was used. The main outcome measure was the amount of supplemental lidocaine 1% used by the surgeon. Subsidiary outcome measures were postoperative pain score, sedative and analgesic requirements before and during surgery, and postoperative analgesic requirements. Median supplemental lidocaine requirements were 100 mg in the superficial block group and 115 mg in the combined block group. These differences were not statistically significant. There was no significant difference in the number of patients needing postoperative analgesia between the groups in the 24 h after surgery. The median time to first analgesia in the superficial block group was 150 min. more than in the combined block group, but this difference, although large, was not statistically significant. No significant differences were found between the anesthetic techniques studied.Comment by Alan Kaye, M.D. Carotid endarterectomy surgery can be performed with regional or general anesthesia. It is probable that a substantial majority of CEAs performed in North America are performed under general anesthesia. Debate over choice of regional versus general anesthesia persists because of various studies of risks and benefits. Each type of anesthesia has its own advantages and disadvantages, which must be considered when choosing the optimal anesthetic for patients. Regional anesthetic techniques available include local infiltration, superficial and deep cervical plexus block, a combination of these with or without contralateral superficial plexus, and cervical epidural anesthesia. This prospective, randomized, double‐blinded study compared superficial versus combined (superficial and deep) cervical plexus block in 40 patients. Outcomes were measured by supplemental local anesthetic used by the surgeon, postoperative pain scores, and sedative and analgesic requirements before, during, and postoperatively. The results showed no significant difference in either study group. Therefore, this small study suggests that superficial block should be preferred in as much that it is relatively easy to do and the potential side‐effects are far less than deep cervical block. Larger studies are warranted in this difficult population of patients.