Use of levobupivacaine in carotid endarterectomy

Background. Аnesthesia for carotid endarterectomy can be used as a combined endotracheal anesthesia, regional anesthesia, and also a combination of combined endotracheal anesthesia with regional anesthesia. Studies have shown that the combination of endotracheal anesthesia with regional anesthesia significantly reduces the need for analgesics after surgery, and the use of levobupivacaine as a local anesthetic reduces the incidence of adverse events.

Aim. To compare the advantages and disadvantages of the combined anesthesia (the combination of endotracheal with regional anesthesia) and the regional anesthesia with sedation using levobupivacaine.

Material and methods. In a prospective single-center study, patients were allocated into 2 groups. In group 1 (n=40), a general anesthesia was performed using desflurane in combination with the regional anesthesia of the superficial cervical plexus. In group 2 (n=40), a blockade of the superficial cervical plexus and deep cervical plexus was achieved. Levobupivacaine was used as a local anesthetic in both groups.

Results. The study showed a significantly (p<0.05) greater number of intraoperative hypertension (BPsys more than 170 mm Hg) episodes in patients of group 1 making 10(25%) versus 4(10%) in group 2, and the presence of hypotension defined as blood pressure less than 90 mm Hg in 5 (12.5 %) patients of group 1 during surgery. In addition, tachycardia (heart rate more than 90 beats per minute) was significantly (p <0.05) more often recorded in group 1: in 8 patients (20%) versus 4 (10%) in group 2. In both groups 1 and 2, adverse events were noted: pain in the intervention area in 4 (10%) patients of group 2, positional discomfort in 3 (7.5%) patients of group 2, sensation of shortness of breath and anxiety in 1 (2.5%) patient of group 2, postoperative nausea in 3 (7.5%) patients of group 1, and postoperative vomiting in 2 (5%) patients of group 1. The time spent in the operating room was significantly longer (p<0.05) in group 1 than in group 2: 110±15 minutes versus 75±12, respectively.

Conclusion. Regional anesthesia reduces the patient's time in the operating room, but the presence of "operating room effect" reduces patient satisfaction compared to general anesthesia in combination with regional anesthesia. Levobupivacaine is effective and safe for both the isolated regional anesthesia and as a component of the combined endotracheal anesthesia for carotid endarterectomy.

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