ABSTRACT
The aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. Overall, 41 (35%) patients needed additional sedation (18 midazolam; 23 remifentanil). There was no intra-operative complication or systemic toxicity of ropivacaine. One regional anaesthesia procedure was converted to general anaesthesia because of patient agitation. Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.
Subject(s)
Carotid Stenosis/surgery , Cervical Plexus Block/methods , Endarterectomy, Carotid/methods , Ultrasonography, Interventional/methods , Aged , Aged, 80 and over , Amides/administration & dosage , Anesthetics, Intravenous/administration & dosage , Carotid Stenosis/diagnostic imaging , Cervical Plexus/diagnostic imaging , Comorbidity , Feasibility Studies , Female , Humans , Male , Prospective Studies , RopivacaineABSTRACT
Allergic reactions to amide local anaesthetic agents are rare. We report the case of a 74-year-old man who suffered anaphylaxis, presenting with cardiovascular collapse, immediately after receiving regional anaesthesia on two separate occasions, the first involving the use of levobupivacaine and the second using ropivacaine. Skin testing revealed positive reactions to both levobupivacaine and ropivacaine, and negative reactions to articaine and lidocaine. Severe allergic reactions can be caused by the amide local anaesthetic drugs, levobupivacaine and ropivacaine.
Subject(s)
Amides/adverse effects , Anaphylaxis/etiology , Anesthetics, Local/adverse effects , Drug Hypersensitivity/etiology , Adrenergic Agents/therapeutic use , Adrenergic alpha-Agonists/therapeutic use , Aged , Anaphylaxis/drug therapy , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods , Bupivacaine/adverse effects , Bupivacaine/analogs & derivatives , Cross Reactions , Drug Hypersensitivity/drug therapy , Ephedrine/therapeutic use , Fat Emulsions, Intravenous/therapeutic use , Humans , Levobupivacaine , Male , Norepinephrine/therapeutic use , Ropivacaine , Skin TestsABSTRACT
We report the case of a reversible postoperative acute renal failure in a 55-year-old woman without preoperative risk factors who underwent a retinal surgery. The association of diuretics with nonsteroidal antiinflammatory drugs was probably responsible of an ischaemic acute tubular necrosis. Vitreoretinal surgery's postoperative period might be associated with a specific risk for the kidney because of an usual intensive diuretic prescription. Nonsteroidal antiinflammatory drugs should be avoided if possible in this indication.
