Cervical plexus block

김진수,고저스틴상욱,방승욱,김형태,이숙영 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.4

Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/ or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.

Autonomic Nerve Block and Severe Hypertension following Combined Superficial and Deep Cervical Plexus Block -A case report-

( Young Kug Kim ),( In Gu Jun ),( Su Jin Kang ),( Jun Gol Song ),( Jae Hyuk Choi ),( Gyu Sam Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6

Although combined superficial and deep cervical plexus (CP) block has been used frequently as regional anesthesia for carotid endarterectomy, it is unclear whether it results in better intraoperative cardiovascular outcome than superficial CP block alone. In this case report, we present a patient who experienced unexpected severe hypertension (267/144 mmHg), accompanied by vagal blockade and vascular sympathetic activation after combined CP block. (Korean J Anesthesiol 2006; 51: S 20~3)

경부종괴 수술시 압박술을 이용한 삭각근 측부 접근법에 의한 경신경총 차단에 관한 연구

김철호,홍기혁 인제대학교 1992 仁濟醫學 Vol.13 No.1

경신경총 차단을 위한 기존의 방법들은 방법상의 어려움이나 치명적인 합병증 때문에 숙련된 마취과 의사가 아니면 시도하기가 꺼려지는 것이 사실이다. 1979년 Vongvises등이 사각근 측부 접근법에 의한 상박신경총 차단을 보고하였는바 저자들은 이 방법에 압박술을 응용하여 경신경총 차단을 시도하여 좋은 결과를 얻을 수 있었다. Thirteen patients were anesthesized with cervical plexus blood by parascalene approach with squeezing technique practiced during the period from May to December 1971 at the Department of Anestheslology, we analysed the cases for the evaluation of efficacy. The results were as follows : 1) This technique is easy to practise and can reduce the dangerous complication compared with the interscalene cervical plexus block. 2) In cases where the lesions are located at interscalene groove, the interscalene technique is difficult to approach but the parascalene approach is not. 3) 5ml or more local anesthetic was needed than was needed in interscalene technique but complications following the dose enhancement were not found.

Ultrasound-guided superficial cervical plexus block for carotid endarterectomy in a patient with Lemierre syndrome -A case report-

최윤숙,조윤이,정월선,이미금 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.4

A 70-year-old woman with an infectious thrombus in her left internal jugular vein (IJV) underwent carotid endarterectomy for stenosis and a highly movable plaque in her right carotid artery. She had been treated with antibiotics for four weeks before surgery due to Lemierre syndrome, a rare septic thrombophlebitis in the IJV secondary to an oropharyngeal infection. The right IJV was in a two-fold dilated state due to compensation for a thrombotic left IJV. Accordingly, superficial cervical plexus block was performed under ultrasound guidance to ensure safety and accuracy. During surgery, the alertness was maintained and the patient did not complain of pain in the absence of additional analgesics. No block-related complications were encountered. The authors report for the first time their regional anesthetic experiences in a patient with Lemierre syndrome.

쇄골수술을 위한 마취에서 표재 목신경얼기 차단과 팔신경얼기 차단 병행 마취와 전신마취와의 비교연구

유재화,유재훈,유규완 순천향대학교 순천향의학연구소 2019 Journal of Soonchunhyang Medical Science Vol.25 No.1

Objective: Recently, the cases about successful regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block for clavicle surgery have been reported. The aim of this study was to compare regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block with general anesthesia. Methods: In this prospective randomized study, 26 patients scheduled for elective clavicle surgery were divided into two groups: the first group was general anesthesia group (GA group, n=13) and the second group for peripheral nerve block group (PNB group, n=13). Standardized general anesthesia was done to the patients assigned to the GA group and ultrasonography-guided combined superficial cervical plexus block and interscalene brachial plexus block was done to the patients assigned to the PNB group. Postoperative sedation scale was assessed at post-anesthesia care unit, and pain scale using 10-cm Visual Analog Scale (VAS) was assessed at immediate postoperative, 30 minutes, 1 hour, 6 hours, and 24 hours. Patients needed additional analgesics, and time for first analgesic demand and duration from surgery to discharge was recorded. Results: The pain VAS scales were less in PNB group than GA group from immediate postoperative time to 6 hours. The patients’ immediate postoperative sedation scale less than 4 were significantly less in PNS group than GA group. The duration from surgery to discharge was shorter in PNS group than GA group. Conclusion: Regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block is a successful alternative to general anesthesia for clavicle surgery.

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

( Wangseok Do ),( Ah-reum Cho ),( Eun-jung Kim ),( Hyae-jin Kim ),( Eunsoo Kim ),( Heon-jeong Lee ) 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

Background: Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA. Methods: Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay. Results: There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p< 0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p<0.001). Conclusion: In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS

( Toshio Iwata ),( Mari Mitoro ),( Naoya Kuzumoto ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.2

To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. Methods: This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ≤ 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores <70 (mild to moderate pain; MM group) and ≥ 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. Results: A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P <0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ≤ 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P <0.05) compared to the controls. Conclusions: Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction. (Korean J Pain 2014; 27: 125-132)

Case Report : Cervicogenic headache arising from hidden metastasis to cervical Lymph node adjacent to the superficial cervical plexus

( Hwan Hee Kim ),( Yong Chul Kim ),( Yong Hee Park ),( Jin Woo Park ),( Jae Hun Kim ),( Soo Young Park ),( Sang Chul Lee ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.2

The differential diagnosis of headache is often difficult because the symptom of headache is overlapping. Superficial cervical plexus block is useful in diagnosis and treatment of headache. Headache arising from the neck and radiating to the frontotemporal regions and possibly to the supraorbital region has been defined as cervicogenic headache. A positive response to anesthetic blocks is one of the diagnostic criteria of cervicogenic headache. We experienced a case of headache arising from direct lymph node metastasis of hepatocellular carcinoma adjacent to the superficial cervical plexus during treatment of cervicogenic headache under ultrasonographic guidance. Especially in patients with medical history of cancer, practitioners should consider the possibility of metastasis to cervical lymph nodes and using ultrasonography to evaluate the cervical area prior to the practice. (Korean J Anesthesiol 2011; 60: 134-137)

기흉을 동반한 쇄골 골절 환지에게 사각근간 차단법과 얕은 목 신경얼기 차단법을 시행한 마취 증례

조용현 ( Yong Hyun Cho ),신광일 ( Kwang Il Shin ),신옥영 ( Ock Young Shin ),김선희 ( Sun Hee Kim ),장원 ( Won Jang ),이현석 ( Hyun Seok Lee ),고현철 ( Hyun Cheol Ko ) 경희대학교 경희의료원 2021 慶熙醫學 Vol.36 No.1

Regional anesthesia is used as an alternative to general anesthesia, and among them, brachial plexus block is widely used in orthopedic upper extremity surgery. The anesthesiologist must make a good decision about which type of nerve block to perform depending on the surgical site. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity This case is a superficial cervical plexus block and interscalene block performed on a patient who was unable to perform general anesthesia using nitrous oxide due to pneumothorax. The patient was discharged after recovery without side effects such as worsening of pneumothorax after surgery.

Effects of bilateral superficial cervical plexus block on sevoflurane consumption during thyroid surgery under entropy-guided general anesthesia: a prospective randomized study

Sudheesh Kannan,Nethra S Surhonne,Chethan Kumar R,Kavitha B,Devika Rani D,Raghavendra Rao R S 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.2

Background: Bilateral superficial cervical plexus block (BSCPB) provides good postoperative analgesia, but its effect on anesthetic consumption is unknown. This study evaluated the effects of BSCPB on sevoflurane consumption during thyroid surgery. Methods: Fifty patients were randomly allocated into groups A and B of 25 each in this prospective double-blind study. Group A received BSCPB with 20 ml 0.25% bupivacaine, whereas group B received 20 ml saline immediately before entropy-guided general anesthesia. Intraoperative hemodynamic parameters, end-tidal sevoflurane concentration, minimum alveolar concentration, and sevoflurane consumption were recorded. Postoperative pain was assessed using a visual analog scale, and the time of the first request for analgesia was noted. All side effects were recorded. Results: Demographics were comparable. Mean sevoflurane consumption [for 30 min: group A = 7.2 (1.1) ml, group B = 8.8 (2.0) ml, P = 0.001; for 60 min: group A = 13.5 (1.7) ml, group B = 16.5 (3.9) ml, P = 0.002] and mean end-tidal sevoflurane concentration [for 30 min: group A = 1.2% (0.2%), group B = 1.4% (0.2%), P = 0.008; for 60 min: group A = 1.2% (0.1%), group B = 1.4% (0.2%), P = 0.010] were significantly lower in group A. Patients in group A had a longer duration of analgesia [361.6 (79.5) min vs. 151.0 (60.2) min, P < 0.001] compared to those in group B. Conclusions: Preinduction BSCPB during thyroid surgery significantly reduced sevoflurane consumption and increased the duration of postoperative analgesia.