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Blog - Cervical Plexus Block

Female patient named Parvathy, age 45 yrs, suffering from hyperthyroidism for a long time presented for right Hemithyroidectomy. She was administered Superficial and Deep Cervical Plexus Block with Dexmed for the surgical procedure.

Thyroidectomy is traditionally performed under General Anaesthesia, however, Cervical Plexus Block has been found to be useful in doing this procedure. Very few centres have the expertise to perform this procedure meticulously.

Cervical plexus has a complex anatomy and is considered as a plexus of loops. The Cervical Plexus Block provides anaesthesia and analgesia to the head and neck region. It is often described as deep and superficial cervical plexus. The deep plexus provides the muscular branches and the superficial plexus provides the innervation of the skin of the head and neck.

Indications:

  • Carotid Endarterectomy
  • Lymph Node dissections and plastic repairs in the Neck region
  • Shoulder Surgery
  • Tracheostomy
  • Thyroidectomy and Parathyroidectomy

Depending on the type of surgery, the plexus can be blocked either at a superficial or a deep level or both.

Superficial cervical plexus block:

  • The superficial branches of the plexus innervate the skin and superficial structures of the head, neck, and shoulder.
  • It consists of a subcutaneous injection of local anaesthetic just under the skin. The landmark is posterior border of the Sternocleidomastoid muscle (SCM) in the Neck.
  • The mid-point of the SCM is marked and from this point local anaesthetic is infiltrated subcutaneously along the superior and inferior border.
  • Around 7-10 ml is injected along the entire muscle border using ultrasound guidance which avoids too deep needle insertion and ensures spread of the local anaesthetic in the correct plane.

Deep cervical plexus block:

  • The deep branches innervate the muscles of the deep anterior neck and the diaphragm.
  • Deep cervical plexus block is a complex regional technique. This technique involves blocking the nerve roots of C2, C3 and C4. The roots of cervical nerves 1 to 7 emerge superior to the transverse process of each cervical vertebra.
  • Using a 22G, 1.5 inch needle, the transverse processes are located by entering perpendicular to the skin. Depth of the transverse process varies from body habitus of the patient (1.5 to 3.0 cm deep)
  • Once bone is contacted, the needle is pulled back slightly and redirected in the cephalic direction. This is repeated until the needle is walked off the bone.
  • After careful aspiration of blood and/ or CSF, 5 ml of local anaesthetic is injected slowly. This is repeated at the other two transverse processes.
  • During the injection, the patient should be communicated continuously to help detect any change in mental status that could occur due to the intravascular injection