CERVICAL PLEXUS BLOCKADE FOR CAROTID SURG ERY - A REPORT OF 313 CONSECUTIVE OPERATIONS

Objectives: The optimal method for protecting the brain from ischaemia during carotid surgery is still a matter of debate. The aim of this s tudy was to report our early results after carotid surgery performed w ith cervical plexus blockade in vigilant patients. Methods: From 1987 to 1992, 313 consecutive operations were performed on the carotid bifu rcation (217 males, 96 females; mean age 67 years; age range 41-87 yea rs). Thirteen underwent bilateral operations at a 1 month interval. Th ere were 118 (38%) asymptomatic patients with carotid narrowing greate r than 80% and 195 (62%) symptomatic patients including 96 with tempor ary cerebral ischaemia, 12 with regressive ischaemic events, 37 with c erebral vascular events and 50 with non-hemispheric events. The contra lateral carotid artery was occluded in 30 patients (9.5%). Deep cervic al blockade of the C2-C3-C4 roots then superficial blockade was obtain ed with 0.5% bupivacaine. Operations were endartectomy (n = 301; 96%) including 59 (18.5%) with a prosthetic patch, venous grafts (n = 8; 2. 5%) and direct reimplantations (n = 3; 0.9%). All neurological complic ations observed during the 30 days following operation were recorded. Results: At occlusion, neurological events occurred in 40 patients (12 .8%) and required the use of a temporary shunt. In patients with a con tralateral occlusion such events occurred in 35.5% of the patients. No cases of myocardial infarction were observed and 1 patient died due t o a neurological cause, giving a morbidity of 1.6% and a mortality of 0.3%. Conclusion: Cervical plexus blockade was shown to be a simple an d effective method for carotid surgery allowing good myocardial haemod ynamics and a reliable evaluation of tolerance to occlusion.