Abstract
PurposeAnatomic variations complicate surface landmark-guided needle placement, thereby increasing nerve blockade failure rate. However, little is understood about how anatomic distances change under different clinical conditions. As the cricoid cartilage is an easy and accurate landmark, we investigated changes in distance between the sixth or seventh cervical transverse processes (C6TP or C7TP) and the cricoid cartilage in neutral and extended supine positions.MethodsForty-two patients (16 men, 26 women) were included in this study. Distances between the cricoid cartilage and C6TP/C7TP were measured using ultrasonography with the patient in neutral and extended supine positions.ResultsC6TP and C7TP were caudally located at 6.0 ± 8.1 and 15.1 ± 7.2 mm, respectively, from the cricoid cartilage in the neutral supine position, and at 15.2 ± 8.0 and 25.3 ± 8.0 mm, respectively, in the extended supine position. In the extended supine position, the cricoid cartilage was more cephalad than C6TP and C7TP in all patients. The distance from the cricoid cartilage to C6TP was 12.1 ± 7.6 mm in men and 17.2 ± 7.7 mm in women.ConclusionC6TP and C7TP are located approximately 15 and 25 mm, respectively, caudal to the cricoid cartilage in the extended supine position. Our results highlight the fact that there can be significant anatomic variation between the extended and neutral supine positions used in stellate ganglion block, which should be kept in mind when devising easily identifiable and palpable surface landmarks.
Highlights
Stellate ganglion block (SGB) is a sympathetic nerve block used in the treatment of head and neck pain, pain of the upper extremities, vascular disease, or sensorineural hearing loss [1]
We evaluated the distance between the cricoid cartilage and C6 transverse process (C6TP) and C7TP when patients are in the neutral supine position and the extended supine position
The cricoid cartilage was positioned, on average, more cephalad than the C6TP and C7TP in the supine position in all except seven patients (16.7 %) in the neutral supine position [six of these seven patients (94.2 %) were men], and in all patients (100 %) in the extended supine position. This means that the targets of SGB, i.e., C6TP and C7TP, should be located caudal to the cricoid cartilage in the extended position
Summary
Stellate ganglion block (SGB) is a sympathetic nerve block used in the treatment of head and neck pain, pain of the upper extremities, vascular disease, or sensorineural hearing loss [1]. Ultrasound or fluoroscopyguided approaches are available, the classical blind technique is mostly used in primary pain clinics, because ultrasound or fluoroscopy-guided techniques require training and are expensive. The fluoroscopy-guided technique is injurious to health because of exposure to radiation. The classical blind technique is associated with risks due to inappropriate needle placement, such as carotid trauma, neural injury, and vascular trauma. The most common classical blind technique used for SGB is the anterior paratracheal approach at the level of the C6TP [2]. In this approach, the patient is placed in the supine position with
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