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BJA Advance Access originally published online on June 18, 2007
British Journal of Anaesthesia 2007 99(2):159-169; doi:10.1093/bja/aem160
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications{dagger}

J. J. Pandit1,*, R. Satya-Krishna2 and P. Gration1

1 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK
2 Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, MI, USA

* Corresponding author. E-mail: jaideep.pandit{at}physiol.ox.ac.uk

Carotid endarterectomy is commonly conducted under regional (deep, superficial, intermediate, or combined) cervical plexus block, but it is not known if complication rates differ. We conducted a systematic review of published papers to assess the complication rate associated with superficial (or intermediate) and deep (or combined deep plus superficial/intermediate). The null hypothesis was that complication rates were equal. Complications of interest were: (1) serious complications related to the placement of block, (2) incidence of conversion to general anaesthesia, and (3) serious systemic complications of the surgical-anaesthetic process. We retrieved 69 papers describing a total of 7558 deep/combined blocks and 2533 superficial/intermediate blocks. Deep/combined block was associated with a higher serious complication rate related to the injecting needle when compared with the superficial/intermediate block (odds ratio 2.13, P = 0.006). The conversion rate to general anaesthesia was also higher with deep/combined block (odds ratio 5.15, P < 0.0001), but there was an equivalent incidence of other systemic serious complications (odds ratio 1.13, P = 0.273; NS). We conclude that superficial/intermediate block is safer than any method that employs a deep injection. The higher rate of conversion to general anaesthesia with the deep/combined block may have been influenced by the higher incidence of direct complications, but may also suggest that the superficial/combined block provides better analgesia during surgery.

Keywords: anaesthetic techniques, regional, cervical plexus; anaesthetics, local; complications, regional anaesthesia; safety, techniques; surgery, vascular, carotid

{dagger} Presented in part at the International Anesthesia Research Society 77th Congress, March 21–25, 2003, New Orleans, LA, USA.


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