Cervical plexus block and carotid endarterectomy in the COVID-19 pandemic: regional anesthesia is the key

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD). Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1 μg kg−1 and mean infusion rate was 0.26 μg kg−1 h−1 (0.21) [mean total dexmedetomidine dose: 154.68 μg (64.65)]. Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68 mg kg (0.84) [mean total propofol dose: 117.72 mg (59.11)]. Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean (standard deviation). Conclusions. Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier NCT01789385.

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Comparison of Clonidine and Epinephrine in Lidocaine for Cervical Plexus Block

Regional Anesthesia The Journal of Neural Blockade in Obstetrics Surgery & Pain Control ◽

10.1136/rapm-00115550-199722020-00006 ◽

1997 ◽

Vol 22 (2) ◽

pp. 137-142

Author(s):

Rowan R. Molnar ◽

Michael J. Davies ◽

David A. Scott ◽

Brendan S. Silbert ◽

Patricia H. Mooney

Keyword(s):

Heart Rate ◽

Carotid Endarterectomy ◽

Plasma Concentrations ◽

Prospective Trial ◽

Onset Time ◽

Maximum Plasma ◽

Cervical Plexus ◽

Double Blind ◽

Cervical Plexus Block ◽

Plexus Block

Background and ObjectivesCarotid endarterectomy under cervical plexus block offers the advantage of awake neurologic assessment. The hypothesis was tested that the addition of clonidine 5 μg/mL to lidocaine 1.5% for the block is as effective clinically as the addition of epinephrine 5 μg/mL but without the associated tachycardia.MethodsIn a double-blind, randomized, prospective trial of 40 patients, local anesthetic solutions of lidocaine 1.5% containing either clonidine 5 μg/mL or epinephrine 5 μg/mL were compared for cervical plexus block in patients undergoing carotid endarterectomy. Each solution was administered to 20 patients with a total lidocaine dose of 7 mg/kg. The electrocardiogram, heart rate, and arterial pressure (radial artery catheter) were continuously monitored. Blood samples were drawn for determination of serum lidocaine levels during the first hour.ResultsThe block onset time (8.4 ± 0.6 minutes for epinephrine, 8.8 ± 0.8 minutes for clonidine) and duration (139 ± 6.7 minutes for epinephrine, 148 ± 5.8 minutes for clonidine) were not different between the two groups. During the period from completion of the block until incision there was a significant heart rate increase in the epinephrine group (23% mean rise) as compared with the clonidine group (4% mean rise) (P < .003). There was no difference in blood pressure between the two groups. The maximum plasma concentrations of lidocaine were 2.5-7.6 μg/mL (mean, 4.5 ± 0.3 μg/mL) for the epinephrine group and 4.7-18.4 μg/mL (mean, 7.5 ± 0.7 μg/mL) for the clonidine group (P < .0002). The maximum concentrations were reached 0-30 minutes (mean, 8 ± 1.4 minutes) after injection for the epinephrine group and 0-10 minutes (mean, 4.5 ± 7.1 minutes) for the clonidine group (P < .03).ConclusionsClonidine 5 μg/mL is a useful additive to lidocaine 1.5% for cervical plexus block to reduce the incidence of tachycardia; however, omission of epinephrine results in higher serum lidocaine levels.

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