Bilateral superficial cervical plexus block with or without low-dose intravenous ketamine analgesia: effective, simple, safe, and cheap alternative to conventional general anesthesia for selected neck surgeries

Abstract

BackgroundGeneral anesthesia is commonly used for surgery in the neck region. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck.MethodsA total of 136 neck surgery cases were enrolled in this prospective uncontrolled study. All patients were administered ropivacaine 0.5% as a bilateral cervical plexus block. The incision line was infiltrated with lignocaine 1% and adrenaline 1:100,000. For thyroglossal cyst and thyroglossal fistula, an additional 1.5 mL of LA solution was deposited over the hyoid bone on both sides of the midline. Any anesthetic inadequacy was corrected using ketamine 25 mg intravenously and repeated if necessary.ResultsOf 37 patients with thyroglossal cyst, the block was sufficient in 36 patients, and one patient required ketamine. Block was adequate in 23 of 24 patients with thyroglossal fistula, and one patient required ketamine. Among the branchial cyst and branchial fistula cases, six of 16 patients required ketamine supplementation. Of three thyroidectomy patients, one required ketamine supplementation, and one was converted to conventional general anesthesia. For lymph node excision and lymph node biopsy patients, LA block was sufficient in all 31 cases. In the last group, one of 25 patients required ketamine supplementation.ConclusionThe overall success of bilateral cervical plexus block as a sole method of anesthesia in these selected neck surgeries was 91.9% and with low-dose ketamine supplementation it approached more than 99%. However, cervical plexus block was not a good method of anesthesia for thyroid surgery in this study. For the remainder of cases, bilateral cervical plexus block alone or in conjunction with ketamine appeared to be a cheap, safe, and effective alternative to conventional general anesthesia.

Evaluation of the Analgesic Effect of Bilateral Superficial Cervical Plexus Block for Thyroid Surgery: A Comparison of Presurgical with Postsurgical Block

“…Clonidine is also known to enhance the efficacy and duration of the block [14] and has been found to decrease postoperative nausea and vomiting [15]. BSCB alone and in combination with ketamine infusion has been successfully used as a sole anaesthetic for thyroid surgery [16].…”

Analgesic Effects of Ultrasound-Guided Serratus-Intercostal Plane Block and Ultrasound-Guided Intermediate Cervical Plexus Block After Single-Incision Transaxillary Robotic Thyroidectomy

“…Although anterior neck surgeries and thyroidectomy could be indications for a bilateral superficial cervical plexus block (CPB), 11 there is a lack of data about the sensory innervations of relatively deep structures, including the sternocleidomastoid (SCM) and infrahyoid muscles, which are separated and retracted during START. Although it is unclear whether the ansa cervicalis transports sensory fibers, 12 the cervical plexus (C2-4) is believed to supply sensation to the SCM muscle.…”

Superficial cervical plexus block in ear surgery: a case report

“…[2] Literatür taramalarında yüzeyel servikal pleksus bloğunun özellikle boyun bölgesinde uygulanan farklı cerrahi işlemlerde anestezik veya postoperatif dönemde analjezik amaçlı kullanımı ile ilgili çalışmalara rastlamak mümkündür. [3,4] Yakın tarihli iki olgu sunumunda ise sadece büyük auriküler sinir bloğu uygulanarak kulağa cerrahi müdahale uygulandığı bildirilmiştir. [5,6] Biz hastamızda daha geniş alanda anestezi sağlamak için YSP bloğu uygulamayı tercih ettik.…”