Peripheral nerve blocks in the cervical region: from anatomy to ultrasound-guided techniques

Saranteas, Theodosios; Kostroglou, Andreas; Efstathiou, G; Giannoulis, Dimitrios; Moschovaki, Nefeli; Mavrogenis, Andreas F.; Perisanidis, Christos

doi:10.1259/dmfr.20190400

Cited by 12 publications

(9 citation statements)

References 46 publications

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“…Many ultrasonographic studies have targeted the cervical plexus for the nerve block to provide adequate anesthesia during neck surgery. [9,10] In addition, dorsal scapular nerve injury is usually reported with neck surgery involving the posterior triangle. [4] However, few studies have focused on the branches of the cervical plexus and the nerves traveling along the SCM.…”

Section: Discussionmentioning

confidence: 99%

Identifying safety zone of invasive procedures in the sternocleidomastoid muscle using ultrasonography

Kang

Yoon

2023

Medicine

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Dysfunctions of the sternocleidomastoid (SCM) muscle, such as myofascial syndrome, torticollis, and cervical dystonia, have been treated using several invasive procedures. In such situations, it is possible to injure the adjacent nerves. This study aimed to demonstrate the course of these nerves in healthy volunteers using ultrasound. The great auricular nerve (GAN), spinal accessory nerve (SAN), transverse cervical nerve (TCN), and supraclavicular nerve (SCN) were scanned by ultrasonography in 26 healthy volunteers. The neck was scanned in the supine position with the head turned 45° to the contralateral side. The cervical plexus was detected in half of the SCM muscle. Each nerve was then traced to the level of contact with the anterior border of the SCM muscle. The following features of the nerves were recorded bilaterally: vertical and horizontal positions of each nerve at the posterior border of the SCM and the cross-sectional area and depth of each nerve at the reference line and anterior border of the SCM. The mean proportions of GAN, SAN, TCN, and SCN were 26%, 26%, 48%, and 80%, respectively near the posterior border, whereas they were 18%, 23%, and 51% for GAN, SAN, and TCN, respectively, at the level of the reference line. Notably, SCN was not visible at the level of the reference line. The mean TCN proportion was 47% at the anterior border of the SCM. The precise location of the nerves and their relationship with the SCM muscle should be considered during invasive procedures. It is recommended that the procedure be performed in the lower half of the SCM muscle, which refers to 50 to 80% of the proportions in our study.

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Section: Discussionmentioning

confidence: 99%

Identifying safety zone of invasive procedures in the sternocleidomastoid muscle using ultrasonography

Kang

Yoon

2023

Medicine

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“…Usually, this block is performed blindly by recognizing the greater horn of the hyoid bone and the superior horn of the thyroid cartilage as anatomic landmarks [ 28 ]. With the clinical application and popularization of ultrasonography (US), US has already been applied to assist the performance of the iSLN block, which is capable of providing detailed imaging of the airway and adjacent anatomy [ 29 ]. The application of US guarantees the precise and effectiveness of the iSLN for each patient, and all patients tolerated the operation well without complications in our study.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Ultrasound-Guided Superior Laryngeal Nerve Block as an Adjuvant to General Anesthesia during Suspension Laryngoscopy Vocal Cord Polypectomy

Zhou

Chen

Xiong

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. In the current study, we assessed the effect of the ultrasound-guided internal branch of the upper laryngeal nerve (USG-guided iSLN) block combined with general anesthesia on perioperative sore throat (POST), cough, hoarseness of voice, intraoperative hemodynamic changes, and the quality of early recovery for the patients undergoing suspension laryngoscopy vocal cord polypectomy (SLVCP). Methods. This was a randomized controlled trail. Eighty patients, aged from 18 to 70 years old, ASA I ∼ II, scheduled for polypectomy of the vocal cord by using a laryngoscope, were randomized into 2 groups (n = 40 each) using a random number table. Patients in group C received general anesthesia (GA), whereas those in group S received USG-guided iSLN block bilaterally (37.5 mg of 0.375% ropivacaine, 5 ml each side) combined with GA. The primary outcome was the quality of patients’ recovery using the Quality of Recovery Questionnaire (QoR-9). The secondary outcomes were postoperative cough, sore throat, hoarseness of voice, and hemodynamic changes in both groups at corresponding time points. The adverse reactions such as postoperative chocking, or aspiration, and dyspnea was recorded as well. Results. The QoR-9 scores of patients in group C were lower than those of group S at time points of D1∼D2 ( P < 0.05 ). Patients in group S had a significantly lower incidence of perioperative cough than those in group C in the early postoperative period (1 hour after extubation) ( P < 0.05 ), the scores of sore throat were lower in group S than those in group C ( P < 0.05 ), the incidence of postoperative hoarseness was increased in group S than that in group C at the time points of 30 min, 2 h, and 4 h after extubation ( P < 0.05 ); however, the incidence of postoperative hoarseness was decreased in group S than that in group C at the time point of 24 h after extubation ( P < 0.05 ). MAP and HR of group S was lower than those of group C at time points of T1∼T4 ( P < 0.05 ). No serious adverse events were observed in both groups. Conclusion. The study found that the application of ultrasound guided superior laryngeal nerve block combined with general anesthesia for the patients undergoing SLVCP could effectively promote the quality of early recovery. Clinical trial registration: This trial is registered with NCT05309174. The date of registration: March 12th 2021.Trial registry name: The Study of Bilateral Upper Laryngeal Nerve Block for Supporting the Removal of Vocal Cord Polyps Under Laryngoscopy.

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“…These are the lesser occipital nerve, the greater auricular nerve, the transverse cervical nerve, and the superior clavicular nerve. 12 A cervical plexus (CP) block is a procedure used to relieve pain in the neck and shoulder areas. This is achieved by injecting a local anesthetic into the CP, a network of nerves in the neck.…”

Section: Introductionmentioning

confidence: 99%

Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment

Chen,

Han,

et al. 2023

J of Cosmetic Dermatology

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BackgroundThermage is a monopolar radiofrequency (RF). It has become an indispensable part of facial and body youthful methods. Although the current device is constantly improving in epidermal cooling techniques and even automatically measures the local impedance value, applying surface anesthesia can take some of the pain away caused by thermage, and the patient's severe pain in the jaw and neck areas is still difficult to resolve.MethodsThe author describes how he uses the combination of the buccal nerve block (BNB) and the superficial cervical plexus block (SCPB) to improve the comfort of the patient's face and neck treatment of patients. It can improve the quality, elasticity, and texture of the skin.ResultsAccording to the author's knowledge of oral and maxillofacial surgery, the combination of BNB and SCPB is applied to the neck and facial analgesia. Combining the BNB and SCPB effectively provides facial and neck anesthesia. The BNB in this technique provides pain relief to the facial skin in the mandibular area and SCPB offers pain relief to the skin of the neck. RF facial rejuvenation treatment often involves the junction of the face and neck to improve the contour of the mandibular margin. Therefore, Whether the RF treatment is aimed at the face or neck, or the treatment is performed simultaneously, we advocate the block both of the buccal nerve and the superficial cervical plexus nerves to achieve perfect analgesia. Still, the dosage of anesthetic medication for the nerve block can be adjusted according to the treatment area.ConclusionWe applied these two nerve blocks and their combination to improve skin laxity with RF therapy for the first time.

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Peripheral nerve blocks in the cervical region: from anatomy to ultrasound-guided techniques

Cited by 12 publications

References 46 publications

Identifying safety zone of invasive procedures in the sternocleidomastoid muscle using ultrasonography

Identifying safety zone of invasive procedures in the sternocleidomastoid muscle using ultrasonography

The Efficacy of Ultrasound-Guided Superior Laryngeal Nerve Block as an Adjuvant to General Anesthesia during Suspension Laryngoscopy Vocal Cord Polypectomy

Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment

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