Cervical plexus Dr. S. Parthasarathy - PowerPoint Presentation

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Cervical plexus

Dr. S. Parthasarathy

MD., DA., DNB, MD (

Acu

),

Dip.

Diab

. DCA, Dip. Software statistics PhD (

physio

),

FICA

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Halsted – 1884

Kappis

Labat – popularized What made it as big hero Carotid endarterectomy

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Cervical plexus

Superficial

a

nd Deep

Anatomy or ANESTHESIA

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In anatomy – there is one cervical plexus

What is special !!

The cervical plexus gives all its motor nerves earlier to be as only sensory nerves later –

This difference enable us to block the sensory component which we call it as SCPB

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Indications

Carotid

endarterectomy

Lymph node dissectionsPlastic repairs (Neck) Shoulder surgery (supplement brachial plexus)TracheostomyThyroidectomy

Parathyroidectomy

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Other indications

Injuries to the ear, neck and

clavicular

region Including clavicular fractures and acromio- clavicular

dislocations

Cervicogenic

headaches

Alone or as

Supplement

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Anatomy

Spinal nerves emerge from the

intervertebral

foramina and pass behind the vertebral artery and vein in the gutter formed by the anterior and posterior tubercles of the corresponding transverse process of the cervical vertebrae.Anterior and posterior rami -Ventral – ascending and descending branches

-Loop

– plexus –

fascial

sheath

Communication with sympathetic chain and

cranial N

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ANATOMY

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Anatomy – superficial

The superficial cervical plexus (SCP) originates from

the anterior

rami of the C2-C4 spinal nerves and gives rise to 4 terminal brancheslesser occipital

greater

auricular

transverse

cervical

supraclavicular nerves

sensory

innervation to the skin and superficial structures

of the

anterolateral neck and sections of the ear and shoulder

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Accessory nerve

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Distribution of skin anesthesia

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Technique of blockade

Middle of the posterior border of

sternocleido

mastoid muscle Face to one side Lift the head and valsalva SCM prominent with EJV Subcutaneous – 5-8 ml both sides Accessory nerve close !!

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USG guided

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Beware what are below

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Both sides we can do

No motor effects

Alone - difficult for surgeon – no motor block

Less side effects Accessory !!!

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Deep cervical plexus block

Para vertebral block of C2 C3 C4 nerves !!

Mastoid to

chassaignac ( C6) – line Posterior line – 1 cm Caudad – 1.5 cm each – Lower border of mandible – C4 Transverse process hit , withdraw 2 mm , inject

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Inject deep to deep fascia -

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Probe placement for deep cervical plexus

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Other approaches

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Behind carotid sheath

place probe lateral

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Trace interscalene

groove and deposit above

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Classical -

TP

Needle

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Drugs for deep cervical plexus block

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Single injection

Thyroid notch – C4

Go up by 2 cm

Give 12-15 ml of local anesthetic

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Dangers

Phrenic

nerve block

Vertebral artery Epidural – no above Subarachnoid 60 % incidence of

phrenic

nerve palsy after DCPB-

hemidiaphragmatic

paresis and heavy sensation

Oxygen, reassurance

Bilateral ??

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Complications

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Complications

Total reversible blindness has also been described after similar inadvertent injections of small amounts (1

mL

) of local anesthetic into a vertebral artery.Carotid sheath compression by injecting the local anesthetic anterior to the transverse processes has been demonstrated by Labat to possibly impair blood flow to the brainCarotid artery Stenosis

??

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Complications

Hematoma can compress pharynx and larynx

Hoarseness secondary to

vagal nerve block or recurrent laryngeal nerve involvement probably occurs more often than previously thought. SCPB -2-3%. May be 60 % with DCPB Horner's syndrome- middle cervical ganglion affected in DCPB Dysphagia may occur with pharyngeal plexus block

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Can decrease complications by

Caudad

only

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Summary

Anatomy

Types

SCPB technique DCPB – techniqueComplications Overall , simplesafe technique

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Thank you all