Superficial and Deep Cervical Blockades Combined with General Anesthesia in Patients Undergoing Total Laryngectomy: Its Effect on Anesthetic Requirements and Postoperative Pain

Background: This study was designed to assess the efficiency of combined bilateral superficial and deep cervical plexus blocks with general anesthesia in patients undergoing total laryngectomy with respect to the anesthetic requirements and postoperative pain. Method: The patients (40) were allocated randomly to one of two groups: General Anesthesia Group (GA) (n~20) and Combined Group (regional and general anesthesia) (n=20). After assessment of the airway, propofol was titrated slowly until loss of verbal contact is achieved, after assessment of adequacy of ventilation, vecuronium 0.1 mg/Kg was given for muscle relaxation, fentanyl was given in a dose lug/kg and then a cuffed endotracheal tube was inserted. The maintenance of anesthesia in both groups was achieved by sevoflurane with fresh gas flow 5 L/min. In Combined Group, after achieving satisfactory level of anesthesia, the patients received combined bilateral superficial and deep cervical plexus block. The hemodynamic goals were to maintain the mean arterial pressure (MAP) at 60-65 mm Hg by adjusting the sevoflurane concentration and the use of esmolol. The consumption of sevoflurane and the Frequency of use of esmolol were evaluated in both groups. Intraoperative blood loss was assessed. In the ICU, VAS pain scores and total morphine consumption were assessed every 3U minutes for 3 hours. Results: The number of patients requiring supplemental fentanyl, and the mean end tidal sevoflurane concentration were significantly increased in GA Group All patients in GA Group required supplemental esmolol to achieve the target MAP, in contrast only 5 patients in the Combined Group required supplemental esmolol (p 0.001). A reduction in blood loss was observed in the Combined Group during the surgical procedure (p 0.001). In the ICU, the total morphine administration (PCA and additional doses) was significantly less in the Combined Group than in the GA Group (7.8 ±2.7 vs. 12.2 ± 1.9, p 0.05). The mean VAS for pain was significantly less in the Combined Group. Conclusion: The combined bilateral superficial and deep cervical block with general anesthesia is an effective technique to reduce anesthetic and analgesic requirements during and after total laryngectomy.