Kruc Anamarija, Lijovic Lada, Skrtic Matteo, Pazur Iva, Perisa Nikola, Radocaj Tomislav
Department of Anaesthesiology, Intensive Care, and Pain Management, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia.
Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
Indian J Anaesth. 2024 Sep;68(9):801-808. doi: 10.4103/ija.ija_834_23. Epub 2024 Aug 16.
Carotid endarterectomy (CEA) is a common procedure conducted under regional anaesthesia, providing real-time cerebral function monitoring. Many different combinations of regional cervical blocks exist, and most offer adequate analgesia in intraoperative and postoperative recovery. This research compares a superficial cervical plexus block (SCB) alone and combined with an ultrasound (US)-guided carotid sheath block (CSB). The primary objective was to explore the length of the sensory block after combining SCB and CSB.
Patients scheduled for nonemergency CEA surgery were randomised into two cohorts. The Subject group (28 participants) received US-guided CSB and SCB. The Control group (31 participants) received only an SCB. Both groups received 0.5% levobupivacaine (2 mg/kg) along with 2% lidocaine (2 mg/kg). The sensory block time and its initiation, analgesia and neutrophil-to-lymphocyte ratio (NLR) were recorded before and after the block. The numeric pain rating scale (NPRS) was used to evaluate analgesia every 2 h for 12 h post block. Analysis of variance, Mann-Whitney U or log-rank test was used to analyse the distinction of selected variables.
The demographic characteristics were comparable across the cohorts. The Subject group demonstrated a significantly accelerated onset of sensory block ( = 0.029) and an extended time to first analgesia ( = 0.003). The sensory block was also substantially extended in the Subject group ( = 0.040). Postoperative pain (NPRS ≥1) within the first 12 h was more recurrent in the Control group ( = 0.048). NLR showed minimal disparity between the groups ( = 0.125).
Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery.
颈动脉内膜切除术（CEA）是在区域麻醉下进行的常见手术，可提供实时脑功能监测。存在许多不同的颈丛阻滞组合，且大多数在术中和术后恢复中提供足够的镇痛效果。本研究比较单纯浅颈丛阻滞（SCB）以及联合超声（US）引导下颈动脉鞘阻滞（CSB）的效果。主要目的是探讨联合SCB和CSB后感觉阻滞的时长。
计划进行非急诊CEA手术的患者被随机分为两个队列。实验组（28名参与者）接受US引导下的CSB和SCB。对照组（31名参与者）仅接受SCB。两组均接受0.5%左旋布比卡因（2mg/kg）以及2%利多卡因（2mg/kg）。在阻滞前后记录感觉阻滞时间及其起始、镇痛效果和中性粒细胞与淋巴细胞比值（NLR）。使用数字疼痛评分量表（NPRS）在阻滞后12小时内每2小时评估一次镇痛效果。采用方差分析、曼-惠特尼U检验或对数秩检验来分析所选变量的差异。
各队列的人口统计学特征具有可比性。实验组显示感觉阻滞起效显著加快（P = 0.029）且首次镇痛时间延长（P = 0.003）。实验组的感觉阻滞也显著延长（P = 0.040）。对照组在前12小时内术后疼痛（NPRS≥1）更频繁（P = 0.048）。两组之间NLR差异最小（P = 0.125）。
联合SCB和US引导下的CSB可有效且安全地延长CEA手术的术后镇痛时间。
