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J J Pandit - One of the best experts on this subject based on the ideXlab platform.
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superficial or deep Cervical Plexus Block for carotid endarterectomy a systematic review of complications
BJA: British Journal of Anaesthesia, 2007Co-Authors: J J Pandit, R Satyakrishna, P GrationAbstract:Carotid endarterectomy is commonly conducted under regional (deep, superficial, intermediate, or combined) Cervical Plexus Block, but it is not known if complication rates differ. We conducted a systematic review of published papers to assess the complication rate associated with superficial (or intermediate) and deep (or combined deep plus superficial/intermediate). The null hypothesis was that complication rates were equal. Complications of interest were: (1) serious complications related to the placement of Block, (2) incidence of conversion to general anaesthesia, and (3) serious systemic complications of the surgical-anaesthetic process. We retrieved 69 papers describing a total of 7558 deep/combined Blocks and 2533 superficial/intermediate Blocks. Deep/combined Block was associated with a higher serious complication rate related to the injecting needle when compared with the superficial/intermediate Block (odds ratio 2.13, P = 0.006). The conversion rate to general anaesthesia was also higher with deep/combined Block (odds ratio 5.15, P P = 0.273; NS). We conclude that superficial/intermediate Block is safer than any method that employs a deep injection. The higher rate of conversion to general anaesthesia with the deep/combined Block may have been influenced by the higher incidence of direct complications, but may also suggest that the superficial/combined Block provides better analgesia during surgery.
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superficial or deep Cervical Plexus Block for carotid endarterectomy a systematic review of complications
BJA: British Journal of Anaesthesia, 2007Co-Authors: J J Pandit, R Satyakrishna, P GrationAbstract:Carotid endarterectomy is commonly conducted under regional (deep, superficial, intermediate, or combined) Cervical Plexus Block, but it is not known if complication rates differ. We conducted a systematic review of published papers to assess the complication rate associated with superficial (or intermediate) and deep (or combined deep plus superficial/intermediate). The null hypothesis was that complication rates were equal. Complications of interest were: (1) serious complications related to the placement of Block, (2) incidence of conversion to general anaesthesia, and (3) serious systemic complications of the surgical-anaesthetic process. We retrieved 69 papers describing a total of 7558 deep/combined Blocks and 2533 superficial/intermediate Blocks. Deep/combined Block was associated with a higher serious complication rate related to the injecting needle when compared with the superficial/intermediate Block (odds ratio 2.13, P = 0.006). The conversion rate to general anaesthesia was also higher with deep/combined Block (odds ratio 5.15, P < 0.0001), but there was an equivalent incidence of other systemic serious complications (odds ratio 1.13, P = 0.273; NS). We conclude that superficial/intermediate Block is safer than any method that employs a deep injection. The higher rate of conversion to general anaesthesia with the deep/combined Block may have been influenced by the higher incidence of direct complications, but may also suggest that the superficial/combined Block provides better analgesia during surgery.
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spread of injectate with superficial Cervical Plexus Block in humans an anatomical study
BJA: British Journal of Anaesthesia, 2003Co-Authors: J J Pandit, D Dutta, J F MorrisAbstract:Background This study was undertaken to investigate why the superficial Cervical Plexus Block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to Block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the deep Cervical fascia and Blocks the Cervical nerves at their roots. Methods Superficial Cervical Plexus Blocks (injections just below the investing fascia) were performed using methylene blue (30 ml) in four cadavers. In one additional control cadaver, a deep Cervical Plexus injection was performed. In a second control cadaver, a subcutaneous injection (superficial to investing fascia) was performed at the posterior border of the sternomastoid muscle. Results Anatomical dissection showed that with superficial Block there was spread of the dye to structures beneath the deep Cervical fascia. In the first control, dye remained in the deep Cervical space. In the second control, dye remained subcutaneous. Conclusions The superficial Cervical space communicates with the deep Cervical space and this may explain the efficacy of the superficial Block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial Cervical Plexus Block is below the investing fascia of the neck, and not just subcutaneous.
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a comparison of superficial versus combined superficial and deep Cervical Plexus Block for carotid endarterectomy a prospective randomized study
Anesthesia & Analgesia, 2000Co-Authors: J J Pandit, Stephen Bree, Patrick Dillon, David Elcock, Ian D Mclaren, Bruce CriderAbstract:Carotid endarterectomy may be performed 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. We compared the two techniques in patients undergoing carotid endarterectomy. Forty patients undergoing carotid endarterectomy were randomized to receive 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 (range 30-180 mg) in the superficial Block group and 115 mg (range 30-250 mg) in the combined Block group. These differences were not statistically significant (Mann-Whitney U-test). There was no significant difference in the number of patients needing postoperative analgesia between the groups (11 of 20 in the deep Block group versus 8 of 20 in the superficial Block group) 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 (median time 45 min) but this difference, although large, was not statistically significant (Mann-Whitney U-test). We found no significant differences between the anesthetic techniques studied. All patients reported satisfaction with the techniques.
Jin Soo Kim - One of the best experts on this subject based on the ideXlab platform.
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incidence of hemi diaphragmatic paresis after ultrasound guided intermediate Cervical Plexus Block a prospective observational study
Journal of Anesthesia, 2020Co-Authors: Ha Yeon Kim, Euy Young Soh, Jeonghun Lee, Sei Hyuk Kwon, Min Hur, Sangkee Min, Jin Soo KimAbstract:An intermediate Cervical Plexus Block (CPB) targets the posterior Cervical space between the sternocleidomastoid muscle and the prevertebral fascia. The phrenic nerve descends obliquely on the surface of the anterior scalene muscle beneath the prevertebral fascia after originating from the C3–C5 ventral rami. Therefore, the phrenic nerve can be affected by a local anesthetic during an intermediate CPB, depending on the permeability characteristics of the prevertebral fascia. This study investigated whether an intermediate CPB affects the phrenic nerve, inducing hemidiaphragmatic paresis. In this prospective observational study, 20 patients undergoing single-incision transaxillary robot-assisted right thyroidectomy were enrolled. The intermediate CPB (0.25% ropivacaine 0.2 ml/kg) was performed at the C4–5 intervertebral level carefully, without penetrating the prevertebral fascia, before the patient emerged from general anesthesia. Diaphragmatic motions of the Block side were measured by M-mode ultrasonography at three time points: before anesthesia (baseline) and at 30 and 60 min after the intermediate CPB. Hemidiaphragmatic paresis was divided into three grades, depending on the percentage of diaphragm movement compared to the baseline: none (> 75%), partial paresis (25–75%), and complete paresis (< 25%). No patient showed any partial or complete ipsilateral hemidiaphragmatic paresis within 60 min after the intermediate CPB. Intermediate CPB using 0.2 ml/kg of 0.25% ropivacaine at the C4–5 intervertebral level did not cause ipsilateral hemidiaphragmatic paresis. This may imply that the effect of the intermediate CPB on the phrenic nerve is not significant.
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incidence of hemi diaphragmatic paresis after ultrasound guided intermediate Cervical Plexus Block a prospective observational study
Journal of Anesthesia, 2020Co-Authors: Ha Yeon Kim, Euy Young Soh, Jeonghun Lee, Sei Hyuk Kwon, Min Hur, Sangkee Min, Jin Soo KimAbstract:Purpose An intermediate Cervical Plexus Block (CPB) targets the posterior Cervical space between the sternocleidomastoid muscle and the prevertebral fascia. The phrenic nerve descends obliquely on the surface of the anterior scalene muscle beneath the prevertebral fascia after originating from the C3-C5 ventral rami. Therefore, the phrenic nerve can be affected by a local anesthetic during an intermediate CPB, depending on the permeability characteristics of the prevertebral fascia. This study investigated whether an intermediate CPB affects the phrenic nerve, inducing hemidiaphragmatic paresis. Methods In this prospective observational study, 20 patients undergoing single-incision transaxillary robot-assisted right thyroidectomy were enrolled. The intermediate CPB (0.25% ropivacaine 0.2 ml/kg) was performed at the C4-5 intervertebral level carefully, without penetrating the prevertebral fascia, before the patient emerged from general anesthesia. Diaphragmatic motions of the Block side were measured by M-mode ultrasonography at three time points: before anesthesia (baseline) and at 30 and 60 min after the intermediate CPB. Hemidiaphragmatic paresis was divided into three grades, depending on the percentage of diaphragm movement compared to the baseline: none (> 75%), partial paresis (25-75%), and complete paresis ( Results No patient showed any partial or complete ipsilateral hemidiaphragmatic paresis within 60 min after the intermediate CPB. Conclusion Intermediate CPB using 0.2 ml/kg of 0.25% ropivacaine at the C4-5 intervertebral level did not cause ipsilateral hemidiaphragmatic paresis. This may imply that the effect of the intermediate CPB on the phrenic nerve is not significant.
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postoperative analgesic effect of ultrasound guided intermediate Cervical Plexus Block on unipolar sternocleidomastoid release with myectomy in pediatric patients with congenital muscular torticollis a prospective randomized controlled trial
Regional Anesthesia and Pain Medicine, 2018Co-Authors: Jin Soo Kim, Han Bum Joe, Myong Chul Park, Hyoeun Ahn, Sook Young Lee, Yun Jeong ChaeAbstract:Background and Objectives Unipolar sternocleidomastoid release with myectomy (USRM) for correction of congenital muscular torticollis in pediatric patients produces moderate to severe postoperative pain. The objective of this trial was to examine the effect of ultrasound-guided intermediate Cervical Plexus Block on postoperative pain after USRM. Methods Thirty-two patients (1–7 years old) were enrolled in this parallel-group, patient- and observer-blinded, randomized controlled trial. In the Block group, 0.25% ropivacaine (0.2 mL/kg) was injected into the interfascial plane between the sternocleidomastoid muscle and the prevertebral fascia under ultrasound guidance at the fourth to fifth Cervical vertebral level. The primary outcome measure was the face, legs, activity, cry, and consolability (FLACC) score at 5 minutes after entering the postanesthesia care unit (PACU), and secondary outcome measures were the FLACC score at discharge from the PACU and 3, 6, and 24 hours after operation and the use of rescue analgesic in the PACU and ward. Results The FLACC score at 5 minutes after admission to the PACU was significantly reduced (3 vs 8; median difference, 4; 95% confidence interval, 1–7; P = 0.044), and the fentanyl dose and the number of patients requiring rescue analgesics in the PACU were significantly lower (0.0 vs 0.5 μg/kg, P = 0.014; 5 [29.4%] vs 12 [75.0%], P = 0.032) in the Block than in the control group. However, after discharge from PACU, there was no difference in FLACC scores and use of rescue analgesics between groups. Conclusions Ultrasound-guided intermediate Cervical Plexus Block decreased immediate postoperative pain and opioid requirements in the PACU in pediatric patients who underwent USRM. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02651311.
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Cervical Plexus Block
Korean Journal of Anesthesiology, 2018Co-Authors: Jin Soo Kim, Seunguk Bang, Hyungtae Kim, Sook Young LeeAbstract:Cervical Plexus Blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the Block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the Cervical fascial layers and Cervical Plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
Frederic Camu - One of the best experts on this subject based on the ideXlab platform.
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ropivacaine 3 75 mg ml 5 mg ml or 7 5 mg ml for Cervical Plexus Block during carotid endarterectomy
Regional Anesthesia and Pain Medicine, 2004Co-Authors: Vincent Umbrain, Viola Van Gorp, E Schmedding, E Debing, Karl Von Kemp, Pierre Van Den Brande, Frederic CamuAbstract:Objective To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of Cervical Plexus Block during carotid endarterectomy. Methods Patients (n = 93) scheduled for carotid endarterectomy were randomized to receive a Cervical Plexus Block with deep infiltration of 10 mL and superficial infiltration of 20-mL volumes of ropivacaine 7.5, 5.0, or 3.75 mg/mL. Pain, coughing, hemodynamic consequences of the Block, postoperative visual analog scores, and pain satisfaction index were recorded. If necessary, anesthesia supplements with aliquots of 3 mL lidocaine 1% were given during surgery. Results Incidences of coughing and hoarseness were similar in all groups. More local anesthetic infiltrations were required in the ropivacaine 3.75-mg/mL and 5-mg/mL groups. Postoperatively, no intragroup differences were observed. A trend toward better pain satisfaction was observed in the ropivacaine 7.5-mg/mL group. Conclusion The best quality of Cervical Plexus Block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.
A. Casati - One of the best experts on this subject based on the ideXlab platform.
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pharmacokinetics of levobupivacaine 0 5 after superficial or combined deep and superficial Cervical Plexus Block in patients undergoing minimally invasive parathyroidectomy
Journal of Clinical Anesthesia, 2008Co-Authors: Tatjana Stopar Pintaric, A. Casati, Marko Hocevar, Gordana Kozelj, Lovro Stanovnik, Vesna Novak JankovicAbstract: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.
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a prospective randomized comparison between combined deep and superficial and superficial Cervical Plexus Block with levobupivacaine for minimally invasive parathyroidectomy
Anesthesia & Analgesia, 2007Co-Authors: Tatjana Stopar Pintaric, A. Casati, Marko Hocevar, Simona Jereb, Vesna Novak JankovicAbstract:BACKGROUND Minimally invasive parathyroidectomy (MIP) can be performed under Cervical Plexus Block (CPB). Superficial CPB has been reported to be easier to perform with similar efficacy and less anesthesia-related complications than combined deep and superficial CPB. In this study, we compared the efficacy of superficial and combined (deep and superficial) CPB in patients undergoing MIP. METHODS Forty-two patients with primary hyperparathyroidism due to a solitary adenoma were randomized to receive either a superficial (group superficial, n = 20) or a combined deep and superficial CPB (group combined, n = 22) using 0.35 mL/kg of 0.5% levobupivacaine. The primary end-point was the amount of supplemental fentanyl required to complete surgery. RESULTS There were no differences in onset of Block, pain scores during surgery, or time to first analgesic request between groups. Fentanyl consumption was similar in both groups, i.e., 50 (0-200) microg in group superficial and 50 (0-100) microg in group combined (P = 0.60). Six patients [1 in group superficial (5%) and 5 in group combined (22.7%)] were converted to general anesthesia for surgically required bilateral neck dissection (P = 0.18). General anesthesia for Block failure was reported in three superficial (15%) and two combined group patients (9%) (P = 0.99). In group combined, only one patient (4.5%) showed diaphragmatic paresis after the Block (P = 0.99). CONCLUSION Superficial CPB is an alternative to combined Block for MIP.
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does clonidine 50 μg improve Cervical Plexus Block obtained with ropivacaine 150 mg for carotid endarterectomy a randomized double blinded study
Journal of Clinical Anesthesia, 2006Co-Authors: G Danelli, A. Casati, M Nuzzi, P F Salcuni, L Caberti, M Berti, E Rossini, Guido FanelliAbstract:Abstract Study Objective To evaluate the effects of adding 50 μ g clonidine to 150 mg ropivacaine for superficial Cervical Plexus Block in patients undergoing elective carotid endarterectomy (TEA). Design Randomized, double-blind study. Setting Departments of Anesthesia and Vascular Surgery of a university hospital. Patients 40 ASA physical status II and III patients undergoing elective TEA during superficial Cervical Plexus Block. Interventions Superficial Cervical Plexus Block was placed using 20 mL of 0.75% ropivacaine alone (Ropi group, n=20) or with the addition of 50 μ g clonidine (Ropi-Clonidine group, n=20). If required, analgesic supplementation was given with local infiltration with 1% lidocaine and intravenous fentanyl (50- μ g boluses). Nerve Block profile, need for intraoperative analgesic supplementation, and time to first analgesic request were recorded. Measurements and Main Results Median (range) onset time was 10 minutes (5-25 min) in the Ropi group and 5 minutes (5-20 min) in the Ropi-Clonidine group ( P μ g [50-300 μ g]) than in patients of the Ropi-Clonidine group (8 mL [0-20 mL] and 0 μ g [0-150 μ g]; P P P > 0.05). Conclusions Adding 50 μ g clonidine to 150 mg ropivacaine for superficial Cervical Plexus Block shortened the onset time and improved the quality of surgical anesthesia in patients undergoing elective TEA.
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Cervical Plexus anesthesia for carotid endarterectomy comparison of ropivacaine and mepivacaine
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2000Co-Authors: A Leoni, G. Fanelli, Silvio Magrin, Giuseppe Mascotto, Andrea Rigamonti, Giorgio Gallioli, Fausto Muzzolon, A. CasatiAbstract:Purpose: To evaluate the effectiveness of Cervical Plexus Block performed with ropivacaine 0.75% or 1%, or mepivacaine 2%.
Bruce Crider - One of the best experts on this subject based on the ideXlab platform.
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a comparison of superficial versus combined superficial and deep Cervical Plexus Block for carotid endarterectomy a prospective randomized study
Anesthesia & Analgesia, 2000Co-Authors: J J Pandit, Stephen Bree, Patrick Dillon, David Elcock, Ian D Mclaren, Bruce CriderAbstract:Carotid endarterectomy may be performed 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. We compared the two techniques in patients undergoing carotid endarterectomy. Forty patients undergoing carotid endarterectomy were randomized to receive 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 (range 30-180 mg) in the superficial Block group and 115 mg (range 30-250 mg) in the combined Block group. These differences were not statistically significant (Mann-Whitney U-test). There was no significant difference in the number of patients needing postoperative analgesia between the groups (11 of 20 in the deep Block group versus 8 of 20 in the superficial Block group) 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 (median time 45 min) but this difference, although large, was not statistically significant (Mann-Whitney U-test). We found no significant differences between the anesthetic techniques studied. All patients reported satisfaction with the techniques.