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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