Cervical Plexus Blocks

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Regional Anaesthesiology

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Cervical Plexus Blocks:

Cervical Plexus Blocks Anatomy, Landmark and Ultrasound Guided blocks By: Behdad Bazargani Anesthesiologist Member of ISRAPM

Anatomy:

Anatomy The anterior branches of the four upper cervical spinal nerves (C1-C4) form the cervical plexus. The plexus lies just lateral to the tips of the transverse processes in the plane just behind the sternocleidomastoid muscle, giving off both cutaneous and muscular branches.

Anatomy:

Anatomy Cutaneous branches: Lesser occipital nerve Great auricular nerve Transverse cervical ( Colli ) nerve Supraclavicular nerves

Anatomy:

Anatomy

Anatomy:

Anatomy Muscular branches: The motor component of the cervical plexus consists of the looped ansa cervicalis (C1-C3), from which the nerves to the anterior neck muscles originate, and various branches from individual roots to posterolateral neck musculature.

Anatomy:

Anatomy Muscular branches : Geniohyoid Prevertebral muscles Sternocleidomastoid Levator scapulae Scalenes Trapezius Diaphragm (phrenic nerve, C3,4,5)

Indications:

Indications Therapeutic Postherpetic neuralgia Occipital and cervicogenic headache Torticollis Surgical Carotid endarterectomy Excision of cervical lymph nodes Plastic surgery in the area of innervation

Absolute or relative contraindications of a Cervical Plexus Block:

Absolute or relative contraindications of a Cervical Plexus Block Contralateral diaphragmatic or recurrent laryngeal nerve paresis Grade II AV block Anticoagulant treatment morbid obesity Partial respiratory failure, regardless of cause Simultaneous bilateral blocks Non-cooperative patients

Local anesthetic:

Local anesthetic Ropivacaine 0.5%-0.75% Bupivacaine 0.25%-0.5% Mepivacaine 1%-2% Xylocaine 1% (for skin)

Preparations:

Preparations Preoperative hypertension control sys<180 mmHg Dias<100 mmHg Intubation kit and ventilation facilities Intravenous access ECG, POM, BP Nasal Oxygen 2-3L/m Emergency drugs Disinfectant skin prep Choosing the right needle

Patient position:

Patient position

Cervical Plexus Block:

Cervical Plexus Block Superficial Intermediate Deep

Cervical Plexus Block:

Cervical Plexus Block

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block The superficial cervical plexus overlies the brachial plexus (i.e., immediately superficial to the interscalene groove and underneath the prevertebral fascia). This can serve as a sonographic landmark.

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block

Superficial Cervical Plexus Block:

Superficial Cervical Plexus Block 10-15 ml of LA must be placed in plexus The onset time for this block is 10 to 20 minutes. The first sign is decreased sensation in the area of distribution of the respective components of the cervical plexus.

Deep Cervical Plexus Block:

Deep Cervical Plexus Block This block is performed as a single (C3 or C4-5) or multiple injection technique (C2, C3, C4). Has a higher risk of accidental involvement of deep structures, such as the carotid and vertebral arteries, the phrenic nerve, dura mater, and the sympathetic trunk.

Deep Cervical Plexus Block:

Deep Cervical Plexus Block

Deep Cervical Plexus Block:

Deep Cervical Plexus Block

Intermediate Cervical Plexus Block:

Intermediate Cervical Plexus Block Injection deep to the investing layer of the neck is termed the “Intermediate cervical plexus block”. Injections placed below the investing fascia of the neck diffuse into deep space , whereas injections placed subcutaneously did not.

Intermediate Cervical Plexus Block:

Intermediate Cervical Plexus Block

Intermediate Cervical Plexus Block:

Intermediate Cervical Plexus Block Refers to an injection of LA in the space between the superficial and deep cervical fascia

Intermediate Cervical Plexus Block:

Intermediate Cervical Plexus Block

Intermediate Cervical Plexus Block:

Intermediate Cervical Plexus Block

Notes:

Notes  Due to the complex arrangement of the sensory innervation of the neck and the cross-coverage from the contralateral side, the anesthesia achieved with a cervical plexus block is rarely complete. Although this should not discourage the use of the cervical block, the surgeon must be willing to supplement the block with a local anesthetic if necessary. A subcutaneous midline injection of local anesthetic extending from the thyroid cartilage distally to the suprasternal notch    will block the branches crossing from the opposite side. This injection can be considered a "field" block. It is useful for preventing pain from surgical skin retractors on the medial aspect of the neck. Carotid surgery requires blockade of the glossopharyngeal nerve branches. The surgeon can accomplish this intraoperatively by injecting local anesthetic inside the carotid artery sheath.

Complications and how to avoid them:

Complications and how to avoid them

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