Case study: Carotid endarterectomy - NYSORA

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Case study: Carotid endarterectomy

May 9, 2024

Case description

A 70-year-old female patient received a diagnosis of severe stenosis of the right internal carotid artery, necessitating a carotid endarterectomy to remove the atherosclerotic plaque. Due to her age and history of stroke, the surgical team opted for regional anesthesia to facilitate neurological monitoring throughout the procedure.

Nerve block technique

The patient was positioned supine with the neck slightly extended and rotated away from the side to be blocked. Using a high-frequency linear ultrasound transducer, the cervical plexus was visualized along the posterior border of the sternocleidomastoid muscle. Under ultrasound guidance, a 22-gauge, 50 mm needle was inserted in-plane. After negative aspiration and confirming correct needle placement, 10 mL of 0.25% bupivacaine was injected incrementally around the cervical plexus, while monitoring for signs of intravascular or intrathecal injection.

Reverse Ultrasound Anatomy for a cervical plexus block with needle insertion in-plane and local anesthetic spread (blue). GaN, greater auricular nerve; SCM, sternocleidomastoid muscle; LCa, longus capitis muscle, LCo, longus colli muscle; MSM, middle scalene muscle; LsCa, longissimus capitis muscle; LS, levator scapulae muscle; SPL, splenius capitis muscle; SECM, semispinalis capitis muscle.

Patient outcome

The carotid endarterectomy was completed under the cervical plexus block, with the patient remaining alert and responsive throughout the surgery. Neurological monitoring during carotid artery clamping revealed no changes, underscoring the advantage of regional anesthesia. Postoperative pain was effectively controlled, and the procedure was free from complications.

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