Comparison of regional anesthesia versus combined regional and general anesthesia for elective carotid endarterectomy: a small exploratory study

Abstract

Background and objectives: This is a small pilot study to compare hemodynamic stability during carotid endarterectomy performed with either regional anesthesia or combined regional/general anesthesia.

Methods: Twenty-eight patients undergoing elective carotid endarterectomy were randomly assigned to: (1) superficial cervical plexus block (n = 14); or (2) superficial cervical plexus block plus general anesthesia (n = 14). The primary outcome measure was hemodynamic stability as indicated by blood pressure changes. Mean arterial pressure was recorded at different times (T(0), T(1), T(2), T(3)). Surgery duration, carotid cross-clamping time, time to recovery of consciousness, perioperative complications, requirement for antihypertensive or antihypotensive drugs, and lidocaine supplementation were recorded. Patients were asked to grade their intraoperative comfort.

Results: In group 1, mean arterial pressure was higher at T(1) and T(2) compared with group 2 (P < .001). Hedges' g effect size was 2.47 (95% confidence interval [CI], 1.48-3.45) at T(1) (very large effect) and 1.36 (95% CI, 0.54-2.18) at T(2) (large effect). Surgery duration was 106 +/- 28 minutes in group 1 versus 91 +/- 16 in group 2 (P = .1026). Carotid cross-clamping time was 45 +/- 14 minutes in group 1 versus 36 +/- 9 in group 2 (P = .0503). Comfort and analgesia were better in group 2 (1.43 +/- 0.65) than in group 1 (2.21 +/- 0.7) (P = .0053).

Conclusions: This pilot study suggests that combined regional/general anesthesia provides greater hemodynamic stability and patient comfort compared with regional anesthesia during carotid endarterectomy. Further studies are warranted before conclusions can be drawn as to the efficacy and safety of the technique.