II. Indications

  1. Anesthesia to anterolateral neck from clavicle to inferior and lateral ear
  2. Catheterization of Internal Jugular Vein
  3. Clavicle Fracture
  4. Laceration Repair

III. Anatomy

  1. Superficial Cervical Plexus (C2-4) supplies four superficial periopheral nerves
    1. Lesser Occipital Nerve
    2. Greater Auricular Nerve
    3. Transverse Cervical Nerve
    4. Suprclavicular Nerve
  2. Risk of adverse effects on nearby structures
    1. Carotid Artery and Internal Jugular Vein are medial to injection site
    2. Brachial Plexus is inferior to injection site
    3. Cervical plexus is deep to injection site

IV. Preparation

  1. Identify and mark landmarks
    1. Lateral neck (posterior aspect of sternocleidomastoid)
    2. Level of superior aspect Thyroid cartilage
  2. Skin Preparation (e.g. Chlorhexidine)
  3. Drape region
  4. Sterile covering over Ultrasound high frequency linear probe (sterile gel inside and outside)
  5. Medication
    1. Confirm maximum dose for Ropivacaine (or Bupivacaine ) to prevent LAST Reaction
    2. Ropivacaine 0.5% (preferred over Bupivacaine 0.25% to 0.5%) 10-15 ml
    3. Syringe 10-20 ml
    4. Needle 25-27 gauge, 1.25 to 1.5 inch

V. Technique

  1. Ultrasound in transverse plane over lateral neck
    1. High frequency linear probe
    2. Roughly at level of superior aspect Thyroid cartilage
    3. Probe overlies posterior aspect of sternocleidomastoid Muscle
  2. Injection Plane
    1. Inject from lateral to medial
      1. Under the lateral border of the sternocleidomastoid Muscle
    2. Target is 1-2 cm deep between sternocleidomastoid Muscle and levator Scapulae Muscle
      1. Posterior aspect of Sternocleidomastoid Muscle (superficial)
      2. Plane containing the Superficial Cervical Plexus
      3. Levator Scapulae Muscle (deep)
  3. Images
    1. superiorCervicalBlockUS.jpg

VI. Adverse Effects

  1. Recurrent laryngeal nerve transient paralysis (hoarse voice)
  2. Brachial Plexus Block (resulting arm motor and sensory effects)
  3. Horner's Syndrome
  4. LAST Reaction (as with any Nerve Block)

VII. References

  1. Hipskind (2020) Cervical Plexus Block, Stat Pearls, accessed 12/21/2020
    1. https://www.ncbi.nlm.nih.gov/books/NBK557382/
  2. Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020
    1. https://stabroom.com/
  3. Ultrasound Guided Cervical Plexus Block, NYSORA, accessed 12/21/2020
    1. https://www.nysora.com/techniques/head-and-neck-blocks/cervical/ultrasound-guided-cervical-plexus-block/

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Ontology: Cervical Plexus Block (C0394689)

Definition (MSH) A blocking of NEURAL CONDUCTION in the network of nerve fibers innervating the neck and shoulder.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D066008
SnomedCT 16139005
CPT 64413
English Injection, anesthetic agent; cervical plexus, N BLOCK INJ CERVICAL PLEXUS, cervical plexus block, N block inj cervical plexus, INJECTION ANESTHETIC AGENT CERVICAL PLEXUS, Block, Cervical Plexus, Plexus Blocks, Cervical, Anesthesia, Cervical Plexus, Plexus Blockades, Cervical, Blocks, Cervical Plexus, Cervical Plexus Anesthesia, Anesthesias, Cervical Plexus, Plexus Anesthesia, Cervical, Cervical Plexus Blockade, Cervical Plexus Blocks, Blockade, Cervical Plexus, Cervical Plexus Block, Plexus Block, Cervical, Plexus Anesthesias, Cervical, Plexus Blockade, Cervical, Cervical Plexus Anesthesias, Blockades, Cervical Plexus, Cervical Plexus Blockades, Injection of anesthetic agent into cervical plexus, Cervical plexus block, Injection of anaesthetic agent into cervical plexus, Injection of anesthetic agent into cervical plexus (procedure)
Spanish inyección de un agente anestésico en el plexo cervical (procedimiento), inyección de un agente anestésico en el plexo cervical

Ontology: Superficial cervical plexus block (C0394691)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 231126002
English Superfic cervical plexus block, Superficial cervical plexus block, Superficial cervical plexus block (procedure)
Spanish bloqueo de plexo cervical superficial (procedimiento), bloqueo de plaxo cervical superficial, bloqueo de plexo cervical superficial, bloqueo de plaxo cervical superficial (procedimiento)