Use of an intermediate cervical plexus block in carotid endarterectomy –an alternative to deep cervical plexus block: A case series

Abstract Background Carotid endarterectomy is performed for patients with symptomatic carotid artery occlusions. Surgery can be performed under general and regional anesthesia. Regional anesthesia is preferable in patients who are medically complicated to undergo anesthesia or in patients for whom cerebral monitoring is not available. Traditionally, surgery is performed under deep cervical plexus block which is technically difficult to perform and can cause serious complications. This case series describes 5 cases in which an intermediate cervical plexus block was used in combination with a superficial cervical plexus block for Carotid endarterectomy surgery. Case presentation Five patients who were classified as American Society of Anesthesiologists 2–3 were scheduled for Carotid endarterectomy due to symptoms and more than 70% occlusion of the carotid arteries. All patients were given superficial cervical plexus block followed by intermediate cervical plexus block using 2% lignocaine and 0.5% plain bupivacaine. Adequate anesthesia was achieved in 4 patients, and local infiltration was necessary in 1 patient. Two patients developed hoarseness of the voice, which settled 2 hours after surgery. Hemodynamic fluctuations were observed in all 5 patients. No serious complications were observed. All 5 patients had uneventful recoveries. Conclusions Superficial cervical plexus block and intermediate cervical plexus block can be used effectively for providing anesthesia for patients undergoing Carotid endarterectomy. It is safe and easier to conduct than deep cervical plexus block and enables monitoring of cerebral function.