Brachial Plexus Blockade as a Result of Aberrant Anatomy After Superficial Cervical Plexus Block

Broderick, Alan; Mannion, Stephen

doi:10.1097/aap.0b013e3181ef4b90

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…The superficial CPB, unlike the deep CPB, is known to carry a low risk of complications and is easy to master [ 12 , 59 , 75 ]. Nonetheless, during a superficial CPB, it is important to make sure that the needle tip is positioned in the subcutaneous tissue to avoid adverse effects of deep block [ 76 , 77 ]. Unilateral or bilateral superficial CPBs can be used as postoperative analgesia after a variety of head and neck surgeries such as thyroidectomy [ 1 , 78 , 79 ], minimally invasive parathyroidectomy [ 59 ], tympanomastoid surgery [ 4 ], anterior cervical discectomy and fusion [ 5 ], and infratentorial and occipital craniotomy [ 80 ].…”

Section: Cervical Plexus Block Methodsmentioning

confidence: 99%

Cervical plexus block

Kim

Bang

et al. 2018

Korean J Anesthesiol

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Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.

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Section: Cervical Plexus Block Methodsmentioning

confidence: 99%

Cervical plexus block

Kim

Bang

et al. 2018

Korean J Anesthesiol

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“…Both superficial and deep cervical plexus blocks have been reported with interscalene blocks, with incidence ranging from 7.7 to 31%. 19,20 The postulated reason has been stated as spilling of the LADM from the interscalene space into the prevertebral fascia. 19 The concomitant blockade of the supraclavicular nerve (a superficial sensory nerve originating from the C-3-4 nerve roots of the superficial cervical plexus supplying the skin over and medial to the acromion) is an additional advantage of interscalene blocks for shoulder surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…This approach may be considered in selected patients where direct administration of cervical plexus block or interscalene block is not possible because of neck pathologies. 20,21 Various studies have consistently demonstrated ipsilateral hemidiaphragmatic paresis in patients who develop HS after brachial plexus block. 3,5e7,22,23 Proposed reason for this is an unintended ipsilateral phrenic nerve paresis after spread of the LADM over the anterior scalene muscle or inadvertent puncture of the thin fascia over the cervical plexus.…”

Section: Discussionmentioning

confidence: 99%

A fluoroscopic assessment of brachial plexus block by the supraclavicular approach: Have we been overmedicating?

Datta¹,

Agrawal

Narula³

et al. 2020

Medical Journal Armed Forces India

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Background: Ultrasonography-guided supraclavicular brachial plexus block has demonstrated safety as compared with landmark or nerve stimulation techniques. However, the minimum effective analgesic volume (MEAV) necessary for adequate blockade has not been determined. This study was undertaken to assess under fluoroscopy the postinjection spread of different drug volumes with clinical correlation. Secondary outcome measures included correlation of onset of block, block quality, and incidence of side effects.Methods: This randomized, multiarm, cross-sectional, observational study was conducted at a single tertiary care center. A total of 549 patients were randomly allocated to 3 groups (20 ml, 30 ml, and 40 ml of drug mixture). A local anesthetic drug mixture with a radiopaque dye was administered under ultrasonographic guidance, and postinjection fluoroscopic drug spread was studied.Results: Surgical anesthesia was achieved in 494 (89.98%) patients with 85.25%, 92.97%, and 91.71% in 20-, 30-, and 40-ml groups, respectively, being significantly low (p ¼ 0.0317) in the 20-mL group. Cephalad and infraclavicular spread was higher in the 40-mL group than in other two groups (p ¼ 0.103). Horner syndrome (HS) was seen in 51.18% of patients. First, ipsilateral superficial cervical plexus block was also observed in 40.22% of patients.Among patients who developed both, ~60% of patients (99/167) belonged to the 40-mL group.Conclusions: Optimal MEAV appears between 20 and 30 mL. Higher drug volumes are associated with more cephalad spread and side effects. Drug spread can predict block efficacy as well. It is postulated that loss of sensation in the ipsilateral neck can be used to predict development of hemidiaphragmatic paresis similar to HS.

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Brachial Plexus Blockade as a Result of Aberrant Anatomy After Superficial Cervical Plexus Block

Cited by 2 publications

References 6 publications

Cervical plexus block

Cervical plexus block

A fluoroscopic assessment of brachial plexus block by the supraclavicular approach: Have we been overmedicating?

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