Optimizing tracheostomy anesthesia: A comparative study of nerve blocks

IF 1.4 Q3 ANESTHESIOLOGY Trends in Anaesthesia and Critical Care Pub Date : 2025-03-01 DOI:10.1016/j.tacc.2025.101541

Tarek I. Ismail , Rabab S.S. Mahrous , Ahmed A. Bedewy

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Abstract

Background

Tracheostomy is increasingly performed as a planned procedure for a wide range of indications. While superficial cervical plexus block (SCPB) is widely used as regional anesthesia for tracheostomy, its limitation in suppressing laryngeal reflexes may lead to discomfort and complications. Combining bilateral SCPB with bilateral superior laryngeal nerve block (SLNB) could potentially improve patient outcomes by reducing airway reflexes.

Objective

This study aimed to compare the effectiveness of bilateral SCPB alone versus bilateral SCPB combined with bilateral SLNB in sedated patients undergoing surgical tracheostomy.

Methods

A double-blind, randomized controlled trial was conducted at Alexandria University Hospital. A total of 120 adult patients, both intubated and non-intubated, requiring elective tracheostomy was randomly allocated into two groups: Group 1 received an ultrasound-guided bilateral SCPB alone, while Group 2 received a combination of ultrasound-guided bilateral SCPB and bilateral SLNB. The primary outcome was the incidence of intraoperative coughing and laryngospasm. Secondary outcomes included postoperative pain, cumulative analgesic requirements, time to first analgesic request, postoperative complications and patients’ satisfaction.

Results

Group 2 (SCPB + SLNB) demonstrated a significantly lower occurrence of coughing and laryngospasm compared to Group 1 (p < 0.05). No significant difference was observed in postoperative pain intensity between the two groups. Additionally, postoperative complications and patients’ satisfaction were comparable between both groups, with no significant differences noted.