An Anatomical Basis for Blocking of the Deep Cervical Plexus and Cervical Sympathetic Tract Using an Ultrasound-Guided Technique

Abstract

The longus capitis muscle is a suitable landmark for blocking the cervical plexus and trunk.

Postoperative Analgesic Effect of Ultrasound-Guided Intermediate Cervical Plexus Block on Unipolar Sternocleidomastoid Release With Myectomy in Pediatric Patients With Congenital Muscular Torticollis

“…[12][13][14]25 The accessory nerve To ensure effective blockade of the sensory branches of the cervical plexus supplying the lower portion of the sternocleidomastoid muscle, and the corresponding skin and platysma muscle, unlike the carotid endarterectomy, we attempted to maintain the injection at the C4-C5 level, because the cervical plexus is situated between the longus capitis and middle scalene muscles. 28 If the injection were to be made at a level higher than C4, it would be possible to spare the lower cutaneous branches of the cervical plexus-the transverse cervical and supraclavicular nerves-in the PCS, 29 especially when using a small volume of local anesthetic. If the injection were to be made too medially in the PCS, it would also be possible to spare the superficial branches of the cervical plexus.…”

Characteristic Ultrasound Feature of Traumatic Neuromas After Neck Dissection: Direct Continuity with the Cervical Plexus

“…The cervical plexus arises between the anterior and posterior tubercles of the transverse process and then moves posterolaterally in a downward direction. The branches of the cervical plexus are located deep inside the sternocleidomastoid muscle, between the longus capitis and scalene medius muscles in upper cervical levels or between the scalene anterior and scalene medius muscles in lower cervical levels (21)(22)(23). By positioning the US probe in an oblique plane, that is, in the postero-infero-lateral direction, this anatomic relationship makes determination of the direct continuity of traumatic neuroma with branches of the cervical plexus more feasible (Fig.…”

“…If the involved nerve was well visualized, its cervical level was determined by following it to the groove, between the anterior and posterior tubercles, of the transverse process. The transverse process of the C7 vertebra was used as an anatomic landmark to assess the cervical level (21,22). From the appearance of involved nerves on US, we categorized each as an injured nerve terminating in a traumatic neuroma with bulbous enlargement of the nerve end, or as a nondisrupted nerve passing through the traumatic neuroma with fusiform enlargement.…”

Ultraschallgesteuerte intermediäre zervikale Plexusanästhesie

“…Diese ist in klinischen Studien evaluiert und stellt bei gleicher Wirksamkeit eine gegenüber tiefen Blockaden nebenwirkungsärmere Technik dar (unterhalb der Lamina praevertebralis; [2,3,5,7,8,12]). Die Nomenklatur des Injektionsorts innerhalb der Fasziendopplung ist uneinheitlich und umfasst Termini wie "posterior …" oder "superficial cervical space" [2,6].…”