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Ǵм Yeungnam Univ J Med 2018;35(1):45-53

ORIGINAL ARTICLE

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

Wangseok Do1, Ah-Reum Cho1, Eun-Jung Kim2, Hyae-Jin Kim1, Eunsoo Kim1, Heon-Jeong Lee1
1Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan;
2Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
Corresponding Author: Ah-Reum Cho, Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea
Tel: +82-51-240-7399, Fax: +82-51-242-7466
E-mail: archo@pusan.ac.kr

Received: January 29, 2018, Revised: March 28, 2018 Accepted: April 9, 2018

Abstract

Background: Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA. Methods: Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay. Results: There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p< 0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.34.6 days in the GA group vs. 8.52.4 days in the RA group, p<0.001). Conclusion: In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Key Words: Keywords: Carotid endarterectomy; Cervical plexus block; Dexmedetomidine; General anesthesia; Ultrasonography

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