The general objective of the study was to assess the analgesic efficacy of bilateral superficial plexus block for thyroid surgery under. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle article pdf available in indian journal of anaesthesia 583. Oct 18, 2016 with ultrasound, the typical morphology of cervical transverse processes from c2 to c7 can be easily revealed fig. Does bilateral superficial cervical plexus block decrease an. Cervical plexus and greater occipital nerve blocks. Good practice and if they are awake, really makes it a completely painless procedure. Deep and superficial cervical plexus anesthesia key. This was done along the superficial cervical plexus plane. Deep and superficial cervical plexus blocks can be used in a variety of surgical procedures, including superficial surgery on the neck and shoulders and thyroid. Facial nerve paralaysis after superficial cervical block. The result with respect to his sporadic neuralgia was satisfactory. A total of 6 neck surgery cases were enrolled in this prospective uncontrolled study. Deep cervical plexus block cervical nerveroots sternocleidomastoidmuscle vertebralbody thyroidgland trachea oesophagus carodsheath fasciaofcarod sheath pretrachealfascia deep cervical fascia invesngfasciaofthe neck skin spinousandtransverseprocessofvertebra intermediate cervical plexus block super. After establishing standard monitoring, anesthesia was induced with fentanyl 12 mcg.
Case report a 70yearold, 48 kg, 153 cm tall woman with a history of hypertension and diabetes was transferred to our hospital for carotid endarterectomy from other hospital. This has shown to be a safe and effective means of providing analgesia. Analgesic efficacy of bilateral superficial cervical plexus. Therefore, a superficial approach to the cervical plexus will not block the greater occipital nerve gon. We hypothesized that using bilateral superficial cervical plexus block bscpb might influence the pattern of immediate postoperative pain and analgesic consumption. Bilateral superficial cervical plexuses block combined. Jul 04, 2018 a cpb that is performed at the cervical paravertebral space c2c4 can block both superficial and deep branches of the cervical plexus simultaneously, although we term it a deep, rather than superficial cpb, given the position at which the block is performed. We invite the authors to detail their experiences, both positive and negative, regarding its use for the alleviation of post. Pdf ultrasound guided selective cervical nerve root.
If the intra operative pain control was inadequate additional 50g fentanyl and 1mg midazolam was given intravenously. Prospective, randomized comparison of deep or superficial. Our findings also indicate that the suitable site of injection for the superficial cervical plexus block is below the investing fascia of the neck, and not just. Comparison of intermediate vs subcutaneous cervical plexus block. Scrutinising the literature reveals that some of the studies that investigated superficial cervical plexus blocks were in fact performing intermediate cervical plexus. The deep cervical plexus block is an advanced block with a risk of potentially serious complications, such as intrathecal injection or injection into the vertebral artery. The patient has moderate to severe pain in that area after intravenous opioid and oral nsaid therapy. Bilateral superficial cervical plexus block is a useful anaesthetic option for thyroidectomy in temperamentally suited patients. Performing an ultrasound guided interscalene brachial plexus block.
Ultrasoundguided placement of combined superficial. Localization of landmarks and direction for performing blockage of superficial branches of cervical plexus6 the cervical plexus block was performed by the. Both motor and sensory block can be obtained by deep cervical plexus block. Stone mda,b, oron frenkel mda, annie chipman mda, arun d. Bilateral superficial cervical plexus block bscbs has been shown to improve postoperative analgesia. We did not understand the authors description of muscle twitch as an endpoint when using a nerve stimulator to guide. The superficial cpb is conventionally described as a subcutaneous injection technique performed at the mid. Also known as the superficial cervical plexus block, blockade of the supraclavicular nerve c34 is a useful adjunct to a supraclavicular brachial plexus block when surgery is performed around the cape of the shoulder fig. Superficial cervical plexus block for urgent tracheostomy koshy rc. At the level of c4 or c5, the superficial cervical plexus can be seen deep to the sternocleidomastoid muscle fig.
Superficial cervical plexus block for management of herpes. Therefore, a metaanalysis of randomized controlled trials rct to evaluate the efficacy and safety of bscpb as an adjunct to. Distribution of anesthesia ultrasound machine with a linear transducer 818 mhz, sterile sleeve, and gel. Pain control using ultrasoundguided superficial cervical. The sensory component of the cervical plexus can be blocked separately and easily by a superficial cervical plexus block. Cervical plexus block an overview sciencedirect topics. Since the intermediate cpb was introduced in addition to superficial and deep cpbs in 2004. A 5 cm, 23 to 25gauge needle attached to lowvolume extension tubing. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform.
The primary aim of this study is to compare the effect of superficial cervical plexus block when added to thoracic epidural analgesia and intravenous patient controlled analgesia pca to standard thoracic epidural analgesia and pca used at our. Both the inplane and outofplane approaches can be performed, and a total of 5 ml of local. Bilateral superficial cervical plexus block combined with. Ultrasoundguided superficial cervical plexus block for. Stellate ganglion block for effective treatment of neuralgia involving the c3 dermatome. Accordingly, the nomenclature of the cpb technique that is performed in the pcs. Spread of injectate with superficial cervical plexus block. Bilateral superficial cervical plexuses block combined with general anesthesia for elective thyroid surgery fentahun tarekegn1, setegn eshetie2 and amare hailekiros3 1department of anesthesia, college of medicine and health sciences, bahir dar university,ethiopia. Deepcervicalplexus block cervicalnerveroots sternocleidomastoidmuscle vertebralbody thyroidgland trachea oesophagus carodsheath fasciaofcarod sheath pretrachealfascia deepcervicalfascia invesngfasciaofthe neck skin spinousandtransverseprocessofvertebra intermediatecervical plexusblock super. Analgesic efficacy of bilateral superficial cervical. Superficial cervical plexus block landmark, ultrasound. In group iii control no regional block was administered. While cervical plexus block is meant to be a sensory block, complications have been reported including facial nerve palsy. The deep plexus block is described in various forms, from extension of brachial plexus.
The objective of this study was to assess its analgesic efficacy in the first 24 hours after thyroid surgery alone and when combined with bilateral deep cervical plexus block bdcbs. The superficial cervical plexus block results in anesthesia of the skin of the anterolateral neck and the anteauricular and retroauricular areas, as well as the skin. With ultrasound, the typical morphology of cervical transverse processes from c2 to c7 can be easily revealed fig. Cervical plexus block nerve cn xi, which innervates. However, it is performed in narrow space of neck area containing many.
For this reason, we will focus primarily on the superficial cervical plexus block technique. Minor transient side effects are common to deep cervical plexus blocks, but they are rarely of any consequence. The analgesia was sufficient to provide anesthesia for the entire surgical repair, but no mention of sustained pain control was included. In addition, because his painful c3 dermatome overlapped significantly with the superficial cervical plexus dermatome, ultrasoundguided superficial cervical plexus block was utilized for pain control of the intractable herpes zoster neuritis in his c3 dermatome. The cervical plexus is a network of nerves formed by communications between the anterior rami of the upper 4 cervical nerves. Superficial cervical plexus block requires 1015 ml of local anesthetic 35 ml per each redirectioninjection. Superficial and intermediate cervical plexus block may result in a similar distribution of local anaesthetic in the tissues if the investing fascia of.
Cervical plexus block carried out by injecting superficial to the prevertebral fascia cannot spread posteriorly to block the posterior rami of the cervical spinal nerves. Combined interscalene brachial plexus and superficial. Thus, a cervical plexus block is properly defined as a block of the anterior rami of c2c4. The analgesic efficacy of bilateral superficial cervical. The superficial cpb is conventionally described as subcutaneous injection technique. Comparisons of superficial vs deep cervical plexus blocks for carotid endarterectomy have either shown equivalence or favored the superficial block due to the lower risk of complications. Although both the deep and superficial cervical plexus blocks can be performed separately, they have been used by some also in combination for anesthesia and.
Ultrasoundguided bilateral superficial cervical plexus block is more. The superficial branches figure 61 of the plexus innervate the skin and superficial structures of. Uses of simple analgesics were found insufficient to manage pain after thyroid surgery. Depending on the type of surgery, the plexus can be blocked either at a superficial or a deep level. A cpb that is performed at the cervical paravertebral space c2c4 can block both superficial and deep branches of the cervical plexus simultaneously, although we term it a deep, rather than superficial cpb, given the position at which the block is performed. Pdf the use of the superficial cervical plexus block in the. Thus the cervical plexus block can also be described as c2c4 compartment block. Nov 19, 2014 after basic trauma evaluation, a mildly displaced fracture is noted on the distal third of the clavicle. The superficial cervical plexus catheter was placed using sterile technique under ultrasound guidance sonosite mturbo.
Figure 1 from cervical plexus block semantic scholar. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck. Both usguided superficial and deep cervical plexus blocks have been well described. Superficial cervical plexus block for neck and shoulder pain. Does bilateral superficial cervical plexus block decrease. To study the effect of ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery. Pdf the use of the superficial cervical plexus block in. Proof of the efficacy of this combination remains weak. Cervical plexus block for thyroidectomy southern african. They are located laterally to the transverse processes between prevertebral muscles from the medial side and vertebral m.
The deep cervical plexus block is an advanced block with a risk of. The nerve stimulator needle is first passed over the skin after aseptic preparation from the distal to proximal part of the posterior border of the sternocleidomastoid. Cervical plexus block cpb has been used in various head and neck surgeries to provide adequate anesthesia andor analgesia. Novel use of superficial cervical plexus nerve block and pecs. The superficial cervical plexus block can be used for many superficial surgeries in the neck area, including lymph node dissection, excision of thyroglossal or branchial cleft cysts, carotid endarterectomy, and vascular access surgery. The superficial cervical space communicates with the deep cervical space and this may explain the efficacy of the superficial block. Superficial cervical plexus block provides the same sensory dermatome anesthesia as deep cervical plexus block, which simply incorporates the motor component of the cervical plexus at the nerve roots before the sensory and motor aspects separate. Recent years have seen an increase in interest in the use of the. Mar 09, 2012 the superficial cervical plexus block is minimal risk procedure equivalent to an iv start. The cervical plexus is a plexus of the anterior rami of the first four cervical spinal nerves which arise from c1 to c4 cervical segment in the neck.
Jul 06, 2017 superficial cervical plexus block technique a nerve stimulator is used to guide the superficial cervical block. Cervical plexus block landmarks and nerve stimulator. They concluded that bscpb is an effective technique with fewer side effects and greater patient satisfaction 16. Novel use of superficial cervical plexus nerve block and. Ten midshaft clavicle fractures were surgically repaired using a combination of an ultrasoundguided interscalene brachial plexus block and a superficial cervical plexus block as the primary anesthetic. Ultrasoundguided placement of combined superficial cervical. A an illustration of the four terminal branches of the superficial cervical plexus. Bilateral superficial cervical plexus block with or. Clinical notes the ultrasoundguided superficial cervical plexus block for anesthesia and analgesia in emergency care settings.
We invite the authors to detail their experiences, both positive and negative, regarding. Intravenous patientcontrolled analgesia was used to evaluate postoperative analgesic requirement. Pdf ultrasound guided superficial cervical plexus and. The ultrasoundguided superficial cervical plexus block for. The influence of bilateral superficial cervical plexuses. Superficial cervical plexus block, muscle twitch and. The superficial cervical plexus block is a technique of blocking the greater auricular, lesser occipital, transverse cervical, and supraclavicular nerves, which are peripheral branches of c1c4. Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery you will receive an email whenever this article is corrected, updated, or cited in.
Superficial cervical plexus highland em ultrasound. May 04, 2015 performing an ultrasound guided interscalene brachial plexus block. It lies posterior to the internal jugular vein and the scm muscles. Cervical plexus block introduction the cervical plexus block provides anesthesia and analgesia to the head and neck region. Regional anesthetic block of the cervical plexus is a safe and useful alternative to general endotracheal anesthesia for surgery of the neck, upper shoulder, and occipital scalp area. Nagdev mda,b adepartment of emergency medicinealameda county medical center, highland general hospital, oakland ca, usa buniversity of california, san francisco ca, usa. Case report a 70yearold, 48 kg, 153 cm tall woman with a history of hypertension and diabetes was transferred to our hospital for carotid endarterectomy from other hospital, where she had been diagnosed with lemierre syndrome. Bilateral superficial cervical plexus block bscpb has been utilized for postoperative pain management of neck surgeries because of its ability to block the emerging branches of the superficial cervical plexus lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves. This is one of the easiest block for procedures on the neck and upper chest infraclavicular region. A combination of bilateral superficial cervical plexus block bscpb and general anesthesia is recommended for thyroid surgery. Cervical plexus block nerve cn xi, which innervates the. The superficial and intermediate plexus blocks are fairly easy to perform. Superficial cervical plexus block, muscle twitch and analgesia.
The cervical plexus originates from the anterior rami of the c1c4 cervical spinal nerves. Additionally, the facial nerve courses though the middle ear. Bilateral superficial cervical plexus block in combination. Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery you will receive an email whenever this article is corrected, updated, or cited in the literature. B the patients skin lesion with the neuralgia due to herpes zoster. Bilateral superficial cervical plexus block using landmark technique was given with 2% lignocaine 7 ml on each side. The superficial cervical plexus block is minimal risk procedure equivalent to an iv start. A multimodal approach to pain control with an ultrasoundguided superior cervical plexus scp block is offered to the patient. Often one needle pass is adequate if the observed local anesthetic spread is deemed optimal. Cervical plexus block landmarks and nerve stimulator technique. During a 20ml local anesthetic injection, the cnp expands from 0. The use of a superficial cervical plexus block for the relief of postoperative laparoscopic shoulder pain is not a technique about which much research has previously been published. The indwelling catheter contiplex stim continuous nerve block tray was placed inplane, and final position was confirmed using ultrasound.
The use of the superficial cervical plexus block in the drainage of submandibular and submental abscessesan alternative for general anesthesia. After basic trauma evaluation, a mildly displaced fracture is noted on the distal third of the clavicle. Superficial cervical plexus block for shoulder pain after. Traditional techniques for the interscalene block typically anesthetize the supraclavicular nerve. Thirty american society of anesthesiologists asa physical status i and ii patients. The blocks can be used for carotid endartrectomy, subclavian vein. Neither complication appears to manifest clinically or cause patient compromise in a large metaanalysis of over 2000 superficial and intermediate cervical plexus blocks in adults2. Evaluation of superficial cervical plexus block for incision. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Cervical plexus blocks cpbs have been used in various head and neck surgeries to provide adequate anesthesia andor analgesia. Superficial cervical plexus block alone or in combination with interscalene brachial plexus block, selective c5 nerve root block and selective supraclavicular nerve block have been reported in the. Superficial cervical plexus highland em ultrasound fueled.