Ultrasound-guided intermediate cervical plexus block for postoperative analgesia in patients undergoing carotid endarterectomy under general anesthesia: a case-control study

Abstract

Aim: The aim of this study is to compare intravenous analgesia (IVA) and intermediate cervical plexus block (ICPB) in terms of acute pain scores and opioid consumption in patients undergoing carotid endarterectomy (CEA) under general anesthesia. Materials and methods: Following the induction of anesthesia, dexketoprofen trometamol 50 mg was administered before the surgical incision, and paracetamol 1 g was given at the end of the surgery and continued at 6 hour intervals for group IVA. Whereas, ultrasound-guided intermediate cervical plexus block was performed in ICPB group. VAS scores, morphine consumption, length of stay, and patient satisfaction status were compared. Results: A total of 109 patients (57 in the IVA group and 52 in the ICPB group) between January 2015 and June 2021 were enrolled. The mean VAS score after extubation was significantly lower in the ICPB group (4.1±1.4 vs 1.2±0.8, p = 0.005). Total morphine consumption was found to be significantly lower in the ICPB group (13.1±4.4 mg vs 3.9±2.4 mg, p < 0.001). The hospital stay was 3.1±1.3 days in the IVA group, while it was 2.2±0.9 days in the ICPB group (p = 0.0014). The patients in the ICPB group were found to be significantly more satisfied (3.4±1.4 vs 1.2±0.8, p < 0.001). Conclusion: Intermediate cervical plexus block provides lower acute pain scores and lower opioid consumption compared to intravenous analgesia in patients undergoing CEA under general anesthesia. In addition, this combined technique shortens the ICU and hospital length of stay and improves patient satisfaction.

Keywords

• carotid endarterectomy
• intermediate cervical plexus block
• analgesia

Genel anestezi altında karotis endarterektomi uygulanan hastalarda postoperatif analjezi için ultrason eşliğinde intermediate servikal pleksus bloğu: vaka kontrol çalışması

Abstract

Amaç: Bu çalışmanın amacı, genel anestezi altında karotis endarterektomi (KEA) uygulanan hastalarda intravenöz analjezi (IVA) ve intermedier servikal pleksus bloğunu (ICPB) akut ağrı skorları ve opioid tüketimi açısından karşılaştırmaktır. Gereç ve yöntem: Anestezi indüksiyonunu takiben, Grup IVA'ya cerrahi kesi öncesi deksketoprofen trometamol 50 mg, operasyon bitiminde 1 gr parasetamol verildi ve 6 saat arayla devam edildi. ICPB grubuna ise ultrason eşliğinde ara servikal pleksus bloğu yapıldı. VAS skorları, morfin tüketimi, hastanede kalış süresi ve hasta memnuniyeti karşılaştırıldı. Bulgular: Ocak 2015 ile Haziran 2021 arasında toplam 109 hasta (IVA grubunda 57 ve ICPB grubunda 52) dahil edildi. Ekstübasyon sonrası ortalama VAS skoru ICPB grubunda anlamlı olarak daha düşüktü (4.1±1.4'e karşı 1.2±0.8, p = 0.005). Toplam morfin tüketimi ICPB grubunda (13.1±4.4 mg vs 3.9±2.4 mg, p < 0.001) anlamlı olarak daha düşük bulundu. Hastanede kalış süresi IVA grubunda 3,1±1,3 gün iken, ICPB grubunda 2,2±0,9 gündü (p=0,0014). ICPB grubundaki hastaların anlamlı olarak daha fazla memnun oldukları bulundu (3.4±1.4'e karşı 1.2±0.8, p < 0.001). Sonuç: İntermediate servikal pleksus bloğu, genel anestezi altında KEA uygulanan hastalarda, intravenöz analjeziye kıyasla daha düşük akut ağrı skorları ve daha düşük opioid tüketimi sağlar. Ayrıca bu kombine teknik, yoğun bakım ve hastanede kalış süresini kısaltır ve hasta memnuniyetini artırır.

Keywords

• karotis endarterektomi
• intermediate servikal pleksus bloğu
• analjezi

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