Ultrasound guided Intermediate Cervical Plexus Block
ARiRA Nerve Block Tips & FAQs
Intermediate Cervical Plexus Block - ARiRA Pro Tips
An intermediate cervical plexus block is a regional anaesthetic technique that targets the sensory branches of the cervical plexus, formed by the anterior rami of the C1-C4 spinal nerves. This block provides sensory anaesthesia to areas such as the anterolateral neck and the skin overlying and below the clavicle.
Patient Positioning: Place the patient supine with the head turned slightly away from the side to be blocked, approximately 45°.
Pillow Adjustment: Place a pillow under the head and upper back on the side opposite to the block. This elevation creates additional space, allowing the anaesthetist's hand and ultrasound probe to manoeuvre comfortably.
Ultrasound Guidance: Utilise a high-frequency linear transducer to visualise the relevant anatomy.
Probe Placement: Place the ultrasound probe transversely at the midpoint of the posterior border of the sternocleidomastoid (SCM) muscle. Optimise the image to lateralise the carotid artery and internal jugular vein, ensuring they are safely out of the needle path.
Anatomical Landmarks: Identify the sternocleidomastoid (SCM) muscle.
Injection Site: Insert the needle at the posterior border of the SCM, targeting the fascial plane between the investing layer of the deep cervical fascia and the prevertebral fascia. Employ an in-plane approach for continuous visualisation of the needle. Insert the needle at a shallow angle to the skin, directing it carefully to avoid penetrating deeper structures or critical vessels.
Always aspirate before injecting to avoid intravascular administration.
Volume of Local Anaesthetic Administration: Inject 7-10 mL of local anaesthetic, ensuring spread around the superficial branches of the cervical plexus below the sternocleidomastoid muscle and investing layer of deep cervical fascia.
Intermediate Cervical Plexus Block - FAQs
Q: What are the primary indications for this block?
A: The intermediate cervical plexus block is commonly used for carotid endarterectomy, clavicle fracture analgesia, and superficial procedures in the anterior and lateral neck regions.
Q: Is this block suitable for deeper neck surgeries?
A: No, this block primarily provides analgesia for superficial neck procedures.
Q: What complications should I watch for?
A: Potential complications include:
Local anaesthetic systemic toxicity (LAST).
Nerve injury due to improper needle placement.
Vascular injury such as carotid artery or jugular vein puncture.
Haematoma or infection.
Q: Can this block cause phrenic nerve palsy?
A: Phrenic nerve palsy is still a possible complication if the anaesthetic spreads to the anterior scalene region.
Q: What is the difference between intermediate and superficial cervical plexus block?
A: Differences include:
Superficial Block: Local anaesthetic is administered within the superficial fascial layers above the SCM.
Intermediate Block: Targets the cervical plexus at a deeper fascial plane between the investing layer of deep cervical fascia and prevertebral fascia.