Regional anesthesia: Edited by Bernadette VeeringRegional anesthesia for carotid surgeryGuay, Joanne Author Information Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada Correspondence to Dr Joanne Guay, MD, FRCPC, Clinical Associate Professor, Anesthesia, Maisonneuve-Rosemont Hospital, 5415, L'Assomption Boulevard, Montreal, Quebec H1T 2M4, Canada Tel: +1 514 252 3426; fax: +1 514 252 3542; e-mail: [email protected] Current Opinion in Anaesthesiology: October 2008 - Volume 21 - Issue 5 - p 638-644 doi: 10.1097/ACO.0b013e328308bb70 Buy Metrics Abstract 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: 300 000 (3.75 μg/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. © 2008 Lippincott Williams & Wilkins, Inc.