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A simple method for blocking the deep cervical nerve plexus using an ultrasound-guided technique.

Cervical plexus block is indicated to aid in head and neck surgery, potentially providing excellent anaesthesia and/or analgesia in the cervical region (1,2). To date, only a few studies have examined the role of ultrasound imaging in the selective blocking of the cervical nerve plexus (2-4).

We report five cases of successful postoperative analgesia after thyroid surgery using an ultrasound-assisted cervical plexus nerve block. In our patients, under general anaesthesia, cervical plexus nerve block was performed bilaterally. An ultrasound machine (Vivid I[R], GE Healthcare, Waukesha, Wisconsin, USA) equipped with a high resolution-linear transducer (5 to 10 MHz) was used. Two-dimensional images at a depth of 3 to 5 cm were taken. After obtaining static sono-anatomic views, the cervical transverse processes (hyperechoic formation with posterior acoustic dropout) were identified in the coronal plane (Figure 1A and Figure 2A). Under ultrasound guidance a 24-gauge needle with extension tubing (Stimulplex[R], B. Braun, Melsungen, Germany) was advanced using the out-of-plane technique through the prevertebral fascia (hyperechoic band underneath sternocleidomastoid muscle) (Figure 3A). After negative aspiration for blood, 20 ml of ropivacaine 0. 25. were injected between the prevertebral fascia and the cervical transverse processes on each side (Figure 4A). Multiple injections of local anaesthetic were performed in the cervical paravertebral space between the C-2 and C-4 transverse processes. Following recovering consciousness from general anaesthesia, the patients were all pain-free and showed a complete sensory block to pinprick in the C-2, C-3 and C-4 nerve dermotomes bilaterally. Early complications including dyspnea, neurotoxicity, cardiotoxicity and positive blood aspiration were not observed.

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The cervical nerve plexus is located at the posterior triangle of the neck that is formed by the cervical prevertebral fascia, the paravertebral muscles and the cervical vertebra (5). In previous studies, complex imaging of the cervical paravertebral space was performed and the very small cervical plexus nerve components were identified (4). We exploited the fact that the cervical nerve plexus runs in the cervical paravertebral space. Easily identified 'imaging landmarks' formed by the sternocleidomastoid, the prevertebral fascia and the cervical transverse processes were used for the injection of local anaesthetic. The high success rate might have been due to the entrapment of the local anaesthetic in the cervical paravertebral space and in the direct spread of the local anaesthetic injections around the cervical nerve plexus.

References

(1.) Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 2007; 99:159-169.

(2.) Roessel T, Wiessner D, Heller AR, Zimmermann T. High-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy. Reg Anesth Pain Med 2007; 32:247-253.

(3.) Sandeman DJ, Griffiths MJ, Lennox AF. Ultrasound guided deep cervical plexus block. Anaesth Intensive Care 2006; 34:240-244. (4.) Usui Y, Kobayashi T, Kakinuma H, Watanabe K, Kitajima T, Matsuno K. An anatomical basis for blocking of the deep cervical plexus and cervical sympathetic tract using an ultrasound-guided technique. Anesth Analg 2010; 110:964-968.

(5.) Saranteas T, Paraskeuopoulos T, Anagnostopoulou S, Kanellopoulos I, Mastoris M, Kostopanagiotou G. Ultrasound anatomy of the cervical paravertebral space: a preliminary study. Surg Radiol Anat 2010; 32:617-622.

T. SARANTEAS

G. G. KOSTOPANAGIOTOU

S. ANAGNOSTOPOULOU

K. MOUROUZIS

T. SIDIROPOULOU

Athens, Greece
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Title Annotation:Correspondence
Author:Saranteas, T.; Kostopanagiotou, G.G.; Anagnostopoulou, S.; Mourouzis, K.; Sidiropoulou, T.
Publication:Anaesthesia and Intensive Care
Article Type:Report
Geographic Code:4EUGR
Date:Sep 1, 2011
Words:538
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