Cervical plexus block

Jin-Soo Kim, Justin Sangwook Ko, Seunguk Bang, Hyungtae Kim, Sook Young Lee
2018 Korean Journal of Anesthesiology  
The cervical plexus block (CPB) provides effective anesthesia and analgesia for the head and neck region [1] [2] [3] [4] [5] [6] [7] ; the most common clinical use for CPBs has been carotid endarterectomy (CEA) [8] [9] [10] [11] [12] . Traditionally, CPBs were classified as deep or superficial [13], but in 2004, Telford and Stoneham [14] suggested the intermediate CPB involving a sub-investing fascial injection in addition to the superficial and deep CPBs on the basis of the cadaveric study by
more » ... andit et al. [15]. In 2010, Choquet et al. [16] attempted to refine the concept of intermediate CPBs using ultrasound technique. Nevertheless, "superficial, " "intermediate, " and "deep" are poorly defined anatomical terms that simply indicate the topographic relationship of the tissue with respect to the skin; therefore, there has been some confusion in the nomenclature and definition of CPBs, particularly the intermediate CPB. Since the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance, which is used to easily identify various important landmarks including muscles, cervical vertebrae, large vessels, nerves, and the cervical fascia [17] . Particularly, understanding the detailed configuration of the cervical fasciae Review Article 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.
doi:10.4097/kja.d.18.00143 pmid:29969890 pmcid:PMC6078883 fatcat:hddyyv5xgvaddd7hqrvb4klpgi