Regional anesthesia for carotid surgery

Purpose of review Evidence from retrospective studies suggests that regional anesthesia reduces the risks of major complications associated with carotid endarterectomy compared with general anesthesia, namely: stroke, stroke/death, death and myocardial infarction. Recent findings A superficial cervical plexus block is the regional anesthetic technique of choice. It is as efficacious as a combined (superficial and deep) cervical plexus block and carries substantially less risk of inducing a life-threatening complication from the block placement than a cervical epidural or a deep cervical plexus block. Lidocaine, mepivacaine, bupivacaine and ropivacaine are all suitable agents for this block but bupivacaine provides the longest duration of postoperative analgesia. The addition of epinephrine 1:300000 (3.75 mu g/ml) reduces maximal blood concentrations of lidocaine and bupivacaine without inducing any adverse hemodynamic effects. Summary The anesthesiologist should learn how to place a superficial cervical plexus block. The technique is easy to master, effective and carries a low risk of inducing a serious complication.