Cervical Block Research Articles

Sonar guided focused parathyroidectomy under cervical block

Presentation of hyperparathyroidism varies and is highly non-specific. The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging. A two-year review of parathyroidectomies performed between January 2013 and December 2014. To reflect on the result of sonar-guided focused parathyroidectomy under SCB. There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings.

Minimally Invasive Parathyroidectomy under Local Cervical Block

Minimally Invasive Parathyroidectomy under Local Cervical Block

Can nerve regeneration on an artificial nerve conduit be enhanced by ethanol-induced cervical sympathetic ganglion block?

This study aimed to determine whether nerve regeneration by means of an artificial nerve conduit is promoted by ethanol-induced cervical sympathetic ganglion block (CSGB) in a canine model. This study involved two experiments—in part I, the authors examined the effect of CSGB by ethanol injection on long-term blood flow to the orofacial region; part II involved evaluation of the effect of CSGB by ethanol injection on inferior alveolar nerve (IAN) repair using polyglycolic acid-collagen tubes. In part I, seven Beagles were administered left CSGB by injection of 99.5% ethanol under direct visualization by means of thoracotomy, and changes in oral mucosal blood flow in the mental region and nasal skin temperature were evaluated. The increase in blood flow on the left side lasted for 7 weeks, while the increase in average skin temperature lasted 10 weeks on the left side and 3 weeks on the right. In part II, fourteen Beagles were each implanted with a polyglycolic acid-collagen tube across a 10-mm gap in the left IAN. A week after surgery, seven of these dogs were administered CSGB by injection of ethanol. Electrophysiological findings at 3 months after surgery revealed significantly higher sensory nerve conduction velocity and recovery index (ratio of left and right IAN peak amplitudes) after nerve regeneration in the reconstruction+CSGB group than in the reconstruction-only group. Myelinated axons in the reconstruction+CSGB group were greater in diameter than those in the reconstruction-only group. Administration of CSGB with ethanol resulted in improved nerve regeneration in some IAN defects. However, CSGB has several physiological effects, one of which could possibly be the long-term increase in adjacent blood flow.

Spinal Accessory Nerve Palsy following Cervical Cooled Radiofrequency Ablation: A Case Report and Review of the Literature

Chronic neck pain is a common cause of functional impairment in the general population. A significant percentage has a component of cervical facet arthropathy for which cervical radiofrequency ablation (RFA) has been successful in treating. We present a case of spinal accessory nerve (SAN) palsy after water-cooled cervical RFA. A 37-year-old female with history of fibromyalgia and occipital neuralgia presented with cervicalgia. Magnetic resonance imaging (MRI) revealed degenerative changes and central canal stenosis at C5-6. After positive result to diagnostic cervical medial branch blocks (MBB), she underwent staged bilateral C2-3-4-5 medial branch watercooled RFA. On subsequent follow up, she noted new left shoulder pain. On exam, difficulty with left arm abduction and scapular winging was noted. Electrodiagnostics (EDX) revealed mild denervation and mild decreased motor units on needle EMG study. Nerve stimulation study of the SAN to the upper trapezius revealed latency prolongation and amplitude reduction, consistent with an acute spinal accessory neuropathy. Repeat EDX study, 7 months later, no longer showed denervation in upper trapezius, normal latency, and improved (although still decreased) amplitude. SAN palsy after multilevel cervical RFA has not been reported in the literature to our knowledge. Cervical RFA is generally considered safe with most complications being transient and minor with no lasting adverse effects. Spinal accessory nerve palsy is one cause of scapular winging. This case highlights the importance of physical exam and knowledge of anatomical structures in promptly diagnosing SAN palsy. Key words: Spinal accessory nerve palsy, medial scapular winging, lateral scapular winging, cervical radiofrequency ablation, cervical facet arthropathy, cervical medial branch blocks, cervicalgia, water-cooled radiofrequency ablation

Subtotal Thyroidectomy with Local Cervical Block Anesthesia in Rural Uganda

Introduction: Thyroid disease remains endemic in many developing nations and is largely the consequence of iodine deficiency. Patients with large goiters may have associated compressive symptoms, hyperthyroidism, or report poor quality of life. Surgery is the principal treatment of large symptomatic goiters but remains particularly challenging in resource-limited settings. Constraints to the surgical management of thyroid disease in Uganda include more advanced disease because of delayed presentation, limited supplies and equipment, limited formal training in endocrine surgery, and limited access to anesthesia.1–4 With a population of >40 million people, Uganda has <100 qualified anesthesia providers, with only a minority of those being physicians.2,3 Owing to this shortage of anesthesia providers in Uganda, some surgeons opt to perform thyroidectomies under local anesthesia. This video demonstrates a subtotal thyroidectomy performed under local cervical block anesthesia for the treatment of a large symptomatic goiter. Materials and Methods: The aim of this video is to provide a demonstration of a subtotal thyroidectomy performed by using only local anesthesia. A 52-year-old female presented with a large symptomatic multinodular goiter. The operation was performed as part of a surgical outreach camp at Nebbi hospital in northwestern rural Uganda.5 Owing to inaccessibility of thyroid replacement hormone and low suspicion for malignant disease, a subtotal thyroidectomy was performed. The patient was alert and conscious throughout the procedure. A 0.25% lidocaine solution with diluted adrenaline was used as local anesthetic.6 The lateral aspect of the sternocleidomastoid muscle is injected bilaterally as it is the standard Kocher incision site. Owing to constraints of the operative facility, the procedure was performed without the use of electrocautery or suction irrigation. Hemostasis was achieved with hand-tied 3-0 or 2-0 silk sutures. The recurrent laryngeal nerve and parathyroid glands were identified intraoperatively. The patient's pain level and phonation can be tested throughout the procedure. The specimen was extracted en bloc and pathology analysis grossly demonstrated multinodular goiter. No drain was placed. Results: An effective subtotal thyroidectomy was performed without intraoperative complication. The patient tolerated the procedure well. The recurrent laryngeal nerve and parathyroid glands were preserved. The operative time was <2 hours and blood loss was minimal. There was no stridor, hoarseness, or symptoms of hypocalcemia identified postoperatively. Gross pathology analysis confirmed suspicion of multinodular goiter. Conclusion: Subtotal thyroidectomy for large symptomatic goiters may be performed safely in a resource-limited setting with the use of local anesthetic only. It is an excellent option for patients when access to anesthesia care is limited or unavailable. No competing financial interests exist. Runtime of video: 4 mins 38 secs

Bilateral Superficial Cervical Plexuses Block Combined With General Anesthesia for Elective Thyroid Surgery

Bilateral Superficial Cervical Plexuses Block Combined With General Anesthesia for Elective Thyroid Surgery

Abstract A15: The relationship between cervical cancer associated genes and human papilloma viruses in rural Africans in Zaria

Abstract Cervical cancer is a major public health problem and one of the leading gynecological cancers in developing nations. Reports from Nigeria, the largest black nation in the world by population, show that the national incidence of cervical cancer is 250/100,000. We sought to evaluate the relationship between cervical cancer associated genes and human papilloma viruses from rural Africans in Zaria, Nigeria using immunohistochemistry and molecular phylogenetics. Selected cervical cancer associated genes sequences which include Ki-67 (NM_002417.4), p53 (AB082923.1), EGFR (NM_005228.3), MYC (M25803.1), KRAS (EF471957.1), TGF-B (AF254794.1) and RB (AH002963.2) genes and HPV 16 (KJ869425.1 E6 and E7 variants), HPV 18 (KJ869426.1), HPV 45 (S40261.1), HPV 6 (A25369.1), HPV 11 (J04351.1), HPV 31 (KJ869427.1) and HPV 33 (KJ869428.1) sequences were retrieved from the gene bank data base. The sequences were aligned and bootstrap at 2000 bp to create a molecular phylogenetic tree. Haematoxylin and Eosin together with immunohistochemistry were performed on fifty formalin-fixed paraffin-embedded (FFPE) tissue blocks using Anti- Ki-67, p53, EGFR, MYC, KRAS, TGF-B and RB monoclonal antibodies. Result from the phylogenetic analysis reveals trichotomized tree showing apparent significant evolutionary relationship between cladogram of HPV16 and MYC; HPV18, HPV6 and KRAS genes; EGFR gene and HPV45. Immunohistochemistry results show multivariate expression of Ki-67, p53, EGFR, MYC, KRAS, TGF-B and RB of proteins from the cervical cancer tissue blocks used. Combination of Ki-67 biomarker and other cervical cancer associated genes together with HPV subtypes-genotyping can serve as useful instruments in proper management of the disease. Citation Format: John Idoko, Mohammed Faruk, Jigo Dangude Yaro, James Oluwa Enemari, Peter Akpulu. The relationship between cervical cancer associated genes and human papilloma viruses in rural Africans in Zaria [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A15.

Adjacent segment degeneration after intervertebral fusion surgery by means of cervical block vertebrae.

The prevalence of cervical block vertebrae is unknown. Furthermore, there is no consensus on the cause of adjacent segment degeneration (ASD) after cervical fusion. (1) What is the incidence of cervical block vertebrae? Is there a gender difference? (2) Among cervical block vertebrae cases, is ASD related to age and segment? And what is the specific relationship? (3) What are the imaging findings and characteristics of this disease? We retrospectively diagnosed cervical block vertebrae cases with bony fusions in any segments of the cervical spine without intervertebral fusion surgery of 33,762 patients reported from 2006 to 2011 in north China. Then the X-ray of the obtained cases were observed and counted. The primary outcome was incidence of ASD according to age and segment. The secondary outcome measures were C2-7 angle in fusion (single segment fusion of lower cervical vertebra) and control groups (randomly selected cases of non-fusion), Cobb's angle of fusion segments, and curvature of each lower cervical segment in the control group. A total of 218 cervical block vertebrae cases were found, with a incidence of 0.65%, and C2-3 represented the highest number of fusion segment cases. There were no significant differences in the incidence by sex. Varying degrees of degeneration in the adjacent segment was present in 112 cases (51.4%). The incidence of ASD increased with age, with the ASD growth rate reaching its peak at the age of 51-60years (55.08%). Cervical curvature shows no significant difference between patients with cervical block vertebrae and normal individuals. The segmental curvature was lower in the fusion group than in the control group, with statistical significance achieved in fusion segments located in C4-5, C5-6, and C6-7, but not C3-4. Fusion segments located in C4-5, C5-6, and C6-7 are more prone to ASD than C3-4. The incidence of ASD in patients with vertebral fusion increases with age. III.

Ultrasound-guided Selective Cervical Nerve Root Block Plus Superficial Cervical Plexus Block for Minimally Invasive Parathyroidectomy.

Objective To explore the efficacy and safety of ultrasound-guided cervical root block (CRB) in patients undergoing minimally invasive parathyroidectomy (MIP).Methods We enrolled 35 patients with hyperparathyroidism undergoing MIP in Peking Union Medical College Hospital.C4-7 nerve roots were identified in ultrasound imaging by the shape of the transverse process.A 50 mm insulated needle was gently introduced by an in-plane approach toward the posterior edge of the nerve root located at the inside of the posterior tubercle.After careful aspiration,a total of 3-4 ml of a mixture of 0.5% ropivacaine and 1% lidocaine was slowly injected.The superficial block was administered at the midpoint of the posterior border of the sternocleidomastoid by injecting 5-6 ml of the same mixture.The patients were administrated with dexmedetomidine during the surgery.All patients were assessed for sensory following the procedure and for pain after the surgery.Results Totally 35 patients successfully received MIP under ultrasound-guided CRB plus superficial block.There was no conversion to general anesthesia,no toxic reaction of local anesthetics,and no intravertebral injection.Hoarseness occurred in 6 patients (17.1%) and Horner syndrome occurred in 3 patients (8.6%).The median cold sensory visual analogue scale score was 1.2 [0,5] points at 10 minutes after the procedure.Patient's satisfaction score was 9.5 points.Conclusion Ultrasound-guided CRB plus superficial block can achieve accurate and safe anesthesia,and it provides lasting analgesic effect during and after MIP.

Efficacy and Safety of Para Cervical Block in Manual Vacuum Aspiration (MVA) - in Low Resource Setting

Objective (s): To determine the safety and effectiveness of para-cervical block for cervical dilatation and uterine evacuation by MVA.Materials and methods: This descriptive (cross-sectional) study was conducted in a low resource set-up at Homna, Upzilla Health Complex Comilla between January 2016 and June 2016. Forty five patients of 1st trimester incomplete abortion of 12 weeks gestation were the target population for manual vacuum aspiration (MVA) for this study. All patients received para cervical block before MVA procedure. Three minutes after application of block, suction and evacuation of uterus was done. Perioperative oral analgesic (Ibuprofen) and anxiolytic (diazepam) were used 30 minutes before procedure in all patients. Before the procedure, all the women were asked to evaluate the level of pain on a visual analog scale ranged from 0-10. Thirty minutes after the procedure, the patient was asked to describe the pain that she had been feeling during MVA by using the same visual analog scale. Visual analog scale was described by: no pain (0 points), slight pain (1-3 points), moderate pain (4-6 points) and severe pain (7-10 points). Patients were followed up for 7 days and were evaluated for complications before leaving the facility and on the 7th day after procedure. A routine USG of lower abdomen was done on 7th post-evacuation day in all patients, which revealed completeness of the procedure. Informed consent was taken from all the patients.Results: All were first trimester incomplete abortion cases. MVA was performed with para cervical block. Para cervical block reduced pain sensation on cervical dilatation. According to VAS 30 (66.67%) patients had mild pain, 3(6.67%) patients had moderate pain and 12(26.67%) patients had no pain during the procedure. Six (13.33%) patients had mild pain and others had no pain after the procedure. There was no severe pain before or after the procedure. Thirty (75.56%) patients discharged before 4 hours and 11 (24.44%) patients discharged after 4 hours of the procedure. No patients had any complications like pervaginal bleeding, infection or retention of product. The cost was minimum and patient’s satisfaction was high.Conclusion: Paracevical block is effective in reducing pain sensation during MVA with a reasonable cost of the procedure.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 70-74

P.2.b.019 - Cognitive performance in patients with major depressive disorder treated with vortioxetine compared with escitalopram and venlafaxine

We evaluated the short-term clinical outcomes of frozen shoulder treatment via shoulder manipulation under ultrasound-guided cervical nerve root block (MUC).This study included frozen shoulder patients who were unresponsive to conservative therapy for at least 6 months and were then treated with MUC. Patients with a rotator cuff tear, calcifying tendinitis, osteoarthritis, or any other shoulder disorder were excluded following X-ray, ultrasound, and magnetic resonance imaging evaluation. Although 25 patients were initially included, three patients were not followed-up for at least 1 year. We investigated a final total of 22 patients; the average age was 58 years and 59% were female. We measured shoulder pain, shoulder range of motion, and American Shoulder and Elbow Surgeons shoulder scores immediately prior to MUC, 1 week after MUC, and 1 year after MUC. A Short-Form 36-Item Health Survey was administered before MUC and 1 year after MUC. We used the Friedman and Wilcoxon signed-rank tests to identify statistical differences. Significance was defined as p < 0.05.MUC significantly improved shoulder pain during motion, range of motion, and American Shoulder and Elbow Surgeons scores 1 week after MUC. This improvement persisted at the 1-year follow-up. Seven of the eight Short-Form 36-Item Health Survey measures were significantly improved 1 year after MUC. One patient (4.5%) developed Horner's syndrome, although symptoms resolved within several hours without treatment.MUC for frozen shoulder was safe and resulted in a significant improvement in shoulder pain and range of motion 1 week after the procedure. This improvement persisted at the 1-year follow-up.

Minimally Invasive Parathyroidectomy

Background: Primary hyperparathyroidism (pHPT) is a common endocrine disease often caused by a single parathyroid adenoma. The only curative therapy for pHPT is parathyroidectomy. Bilateral neck exploration is the conventional technique but various techniques have been developed to minimize the incision, operative time, and/or length of hospital stay, including endoscope-assisted or endoscopic methods.1–7 The open minimally invasive parathyroidectomy (MIP) may be performed under local, cervical block anesthesia with shorter operative time and excellent cure rates in the ambulatory setting.8–12 Methods: The aim of this video is to provide detailed instructions of minimally invasive parathyroidectomy. Results: The diagnosis of pHPT is established by biochemical evaluation followed by preoperative imaging. The patient is placed in the semi-Fowler position. Local cervical block anesthesia is performed by the surgeon. An abbreviated Kocher incision is done, subplatysmal flaps are elevated superiorly, and the median raphe is opened. The recurrent laryngeal nerve is identified and preserved, then the end arterial supply to the parathyroid gland is individually ligated and divided. The parathyroid adenoma is excised, and PTH measurements of the aspirate from the lesion are used to confirm PTH-producing tissue. Intraoperative parathyroid hormone is routinely used to verify biochemical cure. Conclusions: The MIP is superior to other techniques of pHPT treatment. In our experience, 89.4% can be effectively performed without conversion to general anesthesia, the curative rate is higher than standard technique (99.4% vs 97.1%), and fewer complications (1.45% vs 3.1%) with minimized postoperative pain in the outpatient setting.8–11 No competing financial interests exist. Runtime of video: 7 mins 25 secs

Lidocaine and Dexamethasone for Paracervical Block Anesthesia in Women with Missed Abortion : Randomized Controlled Trial

Aim of the work: nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone.This study aimed to assess the efficacy of adding dexamethasone to lidocaine for cervical block anesthesia for prolonging the duration and anesthetic effect in women with missed abortion undergoing vacuum evacuation. Patients and methods: this study is a randomized controlled trial and it was conducted in accordance with the ethical committee protocols and informed consent procedures of Ain Shams University Maternity Hospital during the period between Augusts to December 2016.Sample size was calculated using PASS® version 11 programs, setting the type-1 error (α) at 0.05 and the power (1-β) at 0.8. Conclusion: para cervical block can be used as a safe and effective anesthetic technique in patients who need surgical uterine evacuation of missed abortion. Adding dexamethasone can increase effectiveness and duration of para cervical block. Intraoperative pain level was accepted in 80% of patients, these patients had no or mild to moderate accepted pain. We did not detect any postoperative complications in our patients including (excessive vaginal bleeding, hematoma or general manifestations of lidocaine toxicity) and It is recommended to apply PCB for cases of first trimester missed abortion who require uterine suction evacuation. Lidocaine is preferably mixed with dexamethasone to have better results as regards pain score. It is the anesthetic method of choice especially when general anesthesia is a high risk procedure.

Prognostic Factor Analysis for Management of Chronic Neck Pain: Can We Predict the Severity of Neck Pain with Lateral Cervical Curvature?

ObjectiveAlthough little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors.MethodsBetween March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity.ResultsA total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain.ConclusionWe managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.

A Randomized Controlled Trial Examining the Effect of the Addition of the Mandibular Block to Cervical Plexus Block for Carotid Endarterectomy

Although the cervical plexus block generally provides adequate analgesia for carotid endarterectomy, pain caused by metal retractors on the inferior surface of the mandible is not prevented by the cervical block. Different pain relief methods can be performed for patients who experience discomfort in these areas. In this study, the authors evaluated the effect of mandibular block in addition to cervical plexus block on pain scores in carotid endarterectomy. A prospective, randomized, controlled trial. Training and research hospital. Patients who underwent a carotid endarterectomy. Patients scheduled for carotid endarterectomy under cervical plexus block were randomized into 2 groups: group 1 (those who did not receive a mandibular block) and group 2 (those who received a mandibular block). The main purpose of the study was to evaluate the mandibular block in addition to cervical plexus block in terms of intraoperative pain scores. Intraoperative visual analog scale scores were significantly higher in group 1 (p = 0.001). The amounts of supplemental 1% lidocaine and intraoperative intravenous analgesic used were significantly higher in group 1 (p = 0.001 and p = 0.035, respectively). Patient satisfaction scores were significantly lower in group 1 (p = 0.044). The amount of postoperative analgesic used, time to first analgesic requirement, postoperative visual analog scale scores, and surgeon satisfaction scores were similar in both groups. There was no significant difference between the groups with respect to complications. No major neurologic deficits or perioperative mortality were observed. Mandibular block in addition to cervical plexus block provides better intraoperative pain control and greater patient satisfaction than cervical plexus block alone.

Paraspinous Cervical Nerve Block for Primary Headache

Paraspinous Cervical Nerve Block for Primary Headache

Minimising postoperative pain after head and neck surgery – the use of ultrasound guided superficial cervical plexus nerve block immediately prior to surgery

Minimising postoperative pain after head and neck surgery – the use of ultrasound guided superficial cervical plexus nerve block immediately prior to surgery

Regional anesthesia for carotid surgery : An overview of anatomy, techniques and their clinical relevance

Perioperative care for patients undergoing carotid endarterectomy (CEA) often presents achallenge to the anesthesia provider, as this patient group commonly suffers from awide range of comorbidities. Although clinical trials could not demonstrate asignificant benefit associated with regional anesthesia for outcomes such as insult, cardiac infarction or mortality, many authors concur that regional anesthetic techniques might be preferential in specific patient populations for this type of surgery. This article aims to present an overview of the currently used techniques for regional anesthesia in CEA, as well as discussing their influence on the perioperative outcome. After performing an extensive search of medical databases (Pubmed/Medline) the authors present anarrative analysis and interpretation of recent literature. Currently there is aclear trend towards ultrasound guided regional anesthesia and away from classic landmark based techniques. The literature seems to support the notion that superior and intermediate cervical blocks are safer and less invasive than deep blocks. With regional anesthetic techniques evolving to be more and more complex, the use of ultrasound is becoming increasingly indispensable in the operating theatre. For anesthesiologists with sufficient training and aprofound knowledge of the respective anatomy, regional anesthesia seems to be averitable alternative to general anesthesia for CEA.

Impact of anaesthesia mode on evaluation of LEEP specimen dimensions

ObjectivesTo study the influence of anaesthesia (local by cervical block vs. general or spinal anaesthesia) on height and volume of resection specimens in case of conization treatment for cervical intraepithelial neoplasia (CIN). MethodsProspective observational study of all patients who underwent a first treatment by loop electrosurgical excision procedure (LEEP) for CIN. Height of fresh resection specimens was first measured by the operator and then by the pathologist after formaldehyde fixation. Volume of fresh specimens was measured in a measuring cylinder by fluid displacement. ResultsOne hundred patients were included and 35% of LEEP were performed under local anaesthesia. There was a significant difference in height of specimens depending on anaesthesia mode: after fixation, the average height was 11.2mm in the general or spinal anaesthesia group vs. 8.8mm in the local anaesthesia group (P=0.002). There was also a difference in terms of volume depending on anaesthesia mode: 1.6mL in local anaesthesia group vs. 2.3mm in general and spinal anaesthesia group (P=0.01). ConclusionsAnaesthesia mode has an impact on height and volume of LEEP specimens. In our experience, local anaesthesia could reduce LEEP specimen height.

RETRACTED: Blocking of multiple posterior branches of cervical nerves using a cervical interfascial plane block

RETRACTED: Blocking of multiple posterior branches of cervical nerves using a cervical interfascial plane block