Enhancing postoperative analgesia in carotid endarterectomy patients: The potential of ultrasound-guided carotid sheath block combined with superficial cervical plexus block: A randomised trial.

BACKGROUND AND AIMS

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.

METHODS

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.

RESULTS

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).

CONCLUSION

Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery.