Cervical Plexus Research Articles

Total parotidectomy under local anesthesia: a novel technique.

Parotidectomy is a common procedure usually done for a parotid mass necessitating a histological diagnosis. Operation is normally performed under General anesthesia with a nerve stimulator to facilitate facial nerve stimulation. We describe a new technique with reports of three cases, making total parotidectomy under local anesthesia possible. The ascending cervical branch of cervical plexus and the auriculotemporal nerve were anesthetized by bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective onset of anesthesia was within 15-25 minutes and the operations lasted between 2-3 hours without any complications. This offers advantage in high-risk patients where general anesthesia is contraindicated. The facial nerve can be easily identified with on command movements by the patient rendering the use of nerve stimulator or injection of the dye superfluous. This technique makes total parotidectomy an outpatient procedure and facilitates an early discharge.

Postoperative Analgesic Effect of Ultrasound-Guided Intermediate Cervical Plexus Block on Unipolar Sternocleidomastoid Release With Myectomy in Pediatric Patients With Congenital Muscular Torticollis: A Prospective, Randomized Controlled Trial.

Unipolar sternocleidomastoid release with myectomy (USRM) for correction of congenital muscular torticollis in pediatric patients produces moderate to severe postoperative pain. The objective of this trial was to examine the effect of ultrasound-guided intermediate cervical plexus block on postoperative pain after USRM. Thirty-two patients (1-7 years old) were enrolled in this parallel-group, patient- and observer-blinded, randomized controlled trial. In the block group, 0.25% ropivacaine (0.2 mL/kg) was injected into the interfascial plane between the sternocleidomastoid muscle and the prevertebral fascia under ultrasound guidance at the fourth to fifth cervical vertebral level. The primary outcome measure was the face, legs, activity, cry, and consolability (FLACC) score at 5 minutes after entering the postanesthesia care unit (PACU), and secondary outcome measures were the FLACC score at discharge from the PACU and 3, 6, and 24 hours after operation and the use of rescue analgesic in the PACU and ward. The FLACC score at 5 minutes after admission to the PACU was significantly reduced (3 vs 8; median difference, 4; 95% confidence interval, 1-7; P = 0.044), and the fentanyl dose and the number of patients requiring rescue analgesics in the PACU were significantly lower (0.0 vs 0.5 μg/kg, P = 0.014; 5 [29.4%] vs 12 [75.0%], P = 0.032) in the block than in the control group. However, after discharge from PACU, there was no difference in FLACC scores and use of rescue analgesics between groups. Ultrasound-guided intermediate cervical plexus block decreased immediate postoperative pain and opioid requirements in the PACU in pediatric patients who underwent USRM. This study was registered at ClinicalTrials.gov, identifier NCT02651311.

P126. Identification by ultrasound of a cervical nerve root edema caused by vertebral artery loop

Ultrasound is an excellent modality in imaging of peripheral nerves (Lawande et al., 2014; Suk et al., 2013). Although it is a well-established technique its use is not a first-line diagnostic tool in patients with brachialgias. In this case we report of a 44 years old male, who suffered for years from brachialgia of fluctuating intensity of the right arm. A lax humerus articulation of the same arm was diagnosed in the childhood and treated surgically. Actually the patient reported pain mainly in the C6 dermatome, but also shoulder area (C5). He associated these symptoms with a varicella zoster virus (VZV) affection of the shoulder some weeks ago. Cerebral spinal fluid (CSF) examination showed an altered cell count (11 cells/μL). Viral Plexus neuritis was suggested and antiviral therapy was started. Not congruent were the neurological status (Miller et al., 2000) and the electrophysiological examination of the periphery nerves, both within normal limits. The further results from the CSF suggested no acute viral infection and showed residual post infectious state with elevated IgG-Antibodies for VZV.As part of the further differential diagnosis a sonography of the cervical roots and brachial plexus was realized. It showed an edema of the cervical root C6 and in less degree of C5 and C7. Furthermore the patient had a dominant right vertebral artery (V1 diameter 5,2 mm vs. 1,9 mm of the left side) with coiling in V2-segment next to the affected roots.The MRI of the right plexus and MR-angiography confirmed the diagnosis and showed the elongated vertebral artery with a loop with contact to the affected roots.We suggest that the edema is due to the pulsatile contact of the vertebral artery, concordant to a reported intermittent pulsatile pain of the shoulder and right thumb, combined with a chronic intrathecal irritation, which explains the elevated cell count in the CFS. ConclusionThere are few case reports (Hoon Soo et al., 2010; Ahmed et al., 2014) describing a vertebral loop as origin of radiculopathy but we could not find reports of ultrasound of peripheral nerves for this diagnose. We postulate that routine ultrasound as preliminary evaluation of cervical roots and plexus of patients with brachialgias and diffuse arm pain symptoms could help to improve the diagnostic precision with this high definition and low cost methodology with no adverse events for the patients.

Cervical plexus block.

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.

Sequential parathyroidectomy under cervical plexus anesthesia for secondary hyperparathyroidism with renal function failure

Objective: To summarize the strategy of sequential parathyroidectomy for secondary hyperparathyroidism. Methods: Between January 2009 and December 2017, 32 patients with secondary hyperparathyroidism underwent parathyroidectomy in Department of General Surgery, Peking Union Medical College Hospital. There were 11 male and 21 female patients with a mean age of 51.3 years. Eleven of them underwent bilateral neck exploration under general anesthesia, while the rest of them underwent sequential parathyroidectomy. For the patients with sequential parathyroidectomy, a unilateral neck exploration was performed in the initial operation under cervical plexus blocking anesthesia. Second operation for contralateral parathyroid lesions was performed if the serum intact parathyroid hormone (iPTH) was still higher than 1 000 ng/L or related symptoms were not relieved significantly 6 months later after initial surgery. Fisher exact test was used to compare the date between the 2 groups. Results: In the bilateral exploration group, the serum iPTH level gradually exceeded above 1 000 ng/L in 5 patients during follow-up, and reoperation were performed in 3 patients of them. In the group with sequential parathyroidectomy, the serum iPTH level after initial operation exceeded above 1 000 ng/L in 15 patients. Eleven of them underwent contralateral parathyroidectomy, which decreases the serum iPTH levels to less than 1 000 ng/L in 10 patients. Compared with the sequential parathyroidectomy group (1/11), more patients needed to be treated in the intensive care unit after operation in bilateral exploration group (6/11), although the difference was statistically insignificant (P=0.063). Conclusions: Sequential parathyroidectomy strategy is feasible for the secondary hyperparathyroidism with severe complications. Prospective controlled observation with large sample size is needed to confirm its effect.

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study.

BackgroundCarotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.MethodsMedical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.ResultsThere was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p<0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p<0.001).ConclusionIn this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Optimization of cervical lymph node clinical target volume delineation in nasopharyngeal carcinoma: a single center experience and recommendation.

Nasopharyngeal carcinoma (NPC) are characterized by distinct lymph node metastasis patterns. In order to minimize cervical lymph node irradiation volume, 379 NPC patients with metastatic cervical lymph nodes were eligible for geographic mapping. All lymph nodes were mapped into simulation computed tomography images of a template lymph node negative patient. The proportions of retropharyngeal lymph nodes (RLNs), Level Ib, II, III, IV, Va, Vb and supraclavicular (SCV) lymph nodes were 6.9%, 0.5%, 55.25%, 20.4%, 8.2%, 4.9%, 3.1% and 0.75%, respectively. Based on their distribution profile, we proposed the following modifications: 1. the lateral border of RLNs clinical target volume (CTV) be the medial edge of the internal carotid artery above the level of mastoid process, the medial border be adjacent to the cervical vessels below the free edge of the soft palate; 2. the submandibular gland should not be included in Level Ib; 3. Level II should include the posterior belly of digastric muscle, and the space between the posterior edge of submandibular gland and the anterior edge of sternocleidomastoid muscle; 4. the anterior border of Level III and IV should gradually shift backwards and the CTV only include part of the cervical vessels below the level where the thyroid gland appears; 5. the space of the posterior edge of trapezius muscle also should be included if there are metastatic lymph nodes in the transverse cervical vessle plexus. Our recommendations might adequately encompass metastatic lymph nodes while sparing the organs at risk and reducing adverse events.

Team Approach: Upper-Extremity Numbness.

* Upper-extremity numbness has a wide differential diagnosis and can arise from pathology in the cervical spine, brachial plexus, shoulder, elbow, and hand.* Physical examination must include evaluation of both nerve root and peripheral nerve function to aid in determining if symptoms are due to central or peripheral pathology.* Double-crush syndrome, with both spinal and peripheral etiology, is not uncommon and, if not recognized, may lead to treatment failure.* A team approach including orthopaedic surgeons, neurologists, physiatrists, radiologists, and occupational therapists can be crucial in making the diagnosis and designing the treatment plan.* Nonoperative treatment can include observation, physical and occupational therapy, functional bracing, and injections of corticosteroids and/or local anesthetics.* Operative treatment is appropriate after an appropriate course of nonoperative management has failed or with specific diagnoses in which a delay in definitive treatment may put a patient at risk for long-term functional deficits.

Use of Ultrasound-Guided Superficial Cervical Plexus Block for Pain Management in the Emergency Department

BackgroundAlthough use of the superficial cervical plexus block (SCPB) by anesthesia for perioperative indications is well described, there is a paucity of research on use of SCPB in the emergency department (ED). ObjectiveThis prospective observational study aims to prospectively characterize the feasibility, potential for efficacy, and safety of ultrasound-guided SCPB in a convenience sample of ED patients presenting with painful conditions of the “cape” distribution of the neck and shoulder. MethodsData were gathered prospectively on a convenience sample of 27 patients presenting to a community ED with painful conditions involving the distribution of the SCPB: para-cervical muscle spasm/pain (n = 8), clavicle fractures (n = 7), acromioclavicular joint injuries (n = 3), radicular pain (n = 3), and rotator cuff disorders (n = 6). Pre- and post-block 11-point verbal numeric pain scores (VNPS) were recorded, as was the incidence of any immediate complications. A retrospective chart review looked for delayed complications in the 14-day post-block period. ResultsThe mean 11-point VNPS reduction was 5.4 points (62%). There were no early serious complications and one case each of self-limiting vocal hoarseness and asymptomatic hemi-diaphragmatic paresis. No delayed block-related complications were found. ConclusionsWhile limited by the fact that this was a nonrandomized observational experience with no control group, our findings suggest that SCBP may be safe and have potential for efficacy, and warrants further evaluation in a randomized controlled trial.

Unilateral cervical plexus block for prosthetic laryngoplasty in the standing horse.

Locoregional anaesthetic techniques can facilitate certain surgeries being performed under standing procedural sedation. The second and third spinal cervical nerves (C2, C3) are part of the cervical plexus and provide sensory innervation to the peri-laryngeal structures in people; block of these nerves might permit laryngeal lateralisation surgery in horses. To describe the anatomical basis for an ultrasound-guided cervical plexus block in horses. To compare this block with conventional local anaesthetic tissue infiltration in horses undergoing standing prosthetic laryngoplasty. Cadaveric study followed by a double-blinded prospective clinical trial. A fresh equine cadaver was dissected to characterise the distribution of C2 and C3 to the perilaryngeal structures on the left side. A second cadaver was utilised to correlate ultrasound images with the previously identified structures; a tissue marker was injected to confirm the feasibility of an ultrasound-guided approach to the cervical plexus. In the clinical study, horses were assigned to two groups, CP (n = 17; cervical plexus block) and INF (n = 17; conventional tissue infiltration). Data collection and analyses included time to completion of surgical procedure, sedation time, surgical field conditions and surgeon's perception of block quality. We confirmed that C2 and C3 provided innervation to the perilaryngeal structures. The nerve root of C2 was identified ultrasonographically located between the longus capitis and the cleidomastoideus muscles, caudal to the parotid gland. The CP group was deemed to provide better (P<0.0002) surgical conditions with no differences in the other variables measured. Further studies with larger numbers of horses may be necessary to detect smaller differences in surgical procedure completion time based on the improved surgical filed conditions. For standing unilateral laryngeal surgery, a cervical plexus block is a viable alternative to tissue infiltration and it improves the surgical field conditions.

Ultrasound-guided application of cervical plexus nerve block in radiofrequency ablation of thyroid and parathyroid benign lesions

Objective To investigate the efficacy of ultrasound-guided cervical plexus block in radiofrequency ablation of thyroid and parathyroid benign lesions. Methods One hundred and twenty-five patients with thyroid nodules or hyperparathyroidism, who were undergone ultrasound guided radiofrequency ablation, were randomly assigned to receive either ultrasound-guided cervical plexus block or local infiltration anesthesia, and the pain grading was evaluated by numerical rating scale(NRS). The anesthetic dosage and the effect of thermal ablation surgery of ultrasound-guided cervical plexus block anesthesia and local anesthesia were compared. Results The anesthetic dosage in ultrasound-guided cervical plexus block was lower than that in local infiltration anesthesia(t=17.681, P<0.05). The pain grading of ultrasound-guided cervical plexus block was lower than that of local infiltration anesthesia(χ2=33.738, P<0.05). Conclusions Ultrasound-guided cervical plexus nerve block has lower anesthetic dosage and pain grading in the radiofrequency ablation of thyroid and parathyroid benign lesions, which may be widely applied in clinical. Key words: Ultrasonography; Thyroid nodule; Parathyroid diseases; Radiofrequency ablation; Cervical plexus block; Infiltration anesthesia

Effects of bilateral superficial cervical plexus block on sevoflurane consumption during thyroid surgery under entropy-guided general anesthesia: a prospective randomized study.

BackgroundBilateral superficial cervical plexus block (BSCPB) provides good postoperative analgesia, but its effect on anesthetic consumption is unknown. This study evaluated the effects of BSCPB on sevoflurane consumption during thyroid surgery.MethodsFifty patients were randomly allocated into groups A and B of 25 each in this prospective double-blind study. Group A received BSCPB with 20 ml 0.25% bupivacaine, whereas group B received 20 ml saline immediately before entropy-guided general anesthesia. Intraoperative hemodynamic parameters, end-tidal sevoflurane concentration, minimum alveolar concentration, and sevoflurane consumption were recorded. Postoperative pain was assessed using a visual analog scale, and the time of the first request for analgesia was noted. All side effects were recorded.ResultsDemographics were comparable. Mean sevoflurane consumption [for 30 min: group A = 7.2 (1.1) ml, group B = 8.8 (2.0) ml, P = 0.001; for 60 min: group A = 13.5 (1.7) ml, group B = 16.5 (3.9) ml, P = 0.002] and mean end-tidal sevoflurane concentration [for 30 min: group A = 1.2% (0.2%), group B = 1.4% (0.2%), P = 0.008; for 60 min: group A = 1.2% (0.1%), group B = 1.4% (0.2%), P = 0.010] were significantly lower in group A. Patients in group A had a longer duration of analgesia [361.6 (79.5) min vs. 151.0 (60.2) min, P < 0.001] compared to those in group B.ConclusionsPreinduction BSCPB during thyroid surgery significantly reduced sevoflurane consumption and increased the duration of postoperative analgesia.

Perineural Spread of Nonmelanoma Skin Cancer to the Brachial Plexus: Identifying Anatomic Pathway(s).

Perineural spread leading to brachial plexopathy has recently been described in cases of melanoma. The occurrence and mechanism for nonmelanoma skin cancer spread to the brachial plexus is poorly understood. A retrospective chart review of the Mayo Clinic database was conducted to identify patients with nonmelanoma skin cancer and brachial plexopathy between 2000 and 2017. Inclusion criteria were a history of nonmelanoma skin cancer, a clinical diagnosis of brachial plexopathy, imaging features of perineural spread, and a positive result of examination of a biopsy specimen showing tumor in a skin nerve. Thirty-seven patients with a history of nonmelanoma skin cancer and brachial plexopathy were identified. Inclusion criteria were fulfilled in 2 cases of cutaneous squamous cell carcinoma. One case of recurrent basal cell carcinoma with perineural spread confirmed in the brachial plexus by pathologic examination was excluded because confirmatory evidence of perineural spread from the skin to the brachial plexus was not available. Perineural spread of nonmelanoma skin cancer leading to brachial plexopathy is rare. Our 2 cases and the cases found in the literature demonstrate different entry points to the neural highway resulting in neurologic deficits. The cervical plexus serves as a hub for further spread in certain cases of perineural spread of skin cancer.

Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study.

The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery. Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n=20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n=20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC+T, n=20) received BSCPB with 0.25% bupivacaine plus tizanidine 6mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24h. Compared with Group C, rest and swallowing pain scores in Group SC and Group SC+T were statistically lower at all postoperative time points (p<0.05). Fentanyl consumption was lower in Group SC and Group SC+T than in Group C at time periods 0-4 and 4-8h (p<0.05). Fentanyl consumption was lower in Group SC+T than in Group SC at 0-4h (p=0.006). Total fentanyl consumption was higher in Group C than in the other groups (p<0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC+T than in the other groups (p<0.05). Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache. The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).

Anesthetic management for combined superficial cervical and brachial plexus block with low-dose ropivacaine in one elderly orthopedic patient with multiple systemic diseases: a case report

Anesthetic management for combined superficial cervical and brachial plexus block with low-dose ropivacaine in one elderly orthopedic patient with multiple systemic diseases: a case report

Relationship between neuropathy proximal to the suprascapular nerve and rotator cuff tear in a rodent model.

Rotator cuff tears are believed to coexist with cervical spine lesions. In cases of preexisting neuropathy, such as cervical spine lesions, fatty degeneration has likely already occurred due to the neuropathy. In these cases, rotator cuff tear is thought to occur easily because of preexisting extensive fatty degeneration and degeneration of the tendons due to neuropathy. This study aimed to evaluate the effects of paralysis due to neuropathy proximal to the suprascapular nerve on the supraspinatus and infraspinatus tendons using a rat model of brachial plexus paralysis. This study included fifteen, 8-week-old Sprague-Dawley rats. The left shoulder was included in the paralysis group and the contralateral shoulder constituted the sham group. Biomechanical testing (evaluated maximum tear force, maximum displacement and Young's modulus) (n=10) and histological analyses (n=5) (using the Bonar scale) were performed at 12 weeks postoperatively to confirm the degeneration of the tendon. The mean maximum tear force was significantly lower in the paralysis group than in the sham group (P=0.008), indicating that rotator cuff tears occurred with a lower force in the paralysis group. Additionally, the average Young's modulus was significantly greater in the paralysis group than in the sham group (P=0.003), indicating that the rotator cuff muscle became hard and inflexible in the paralysis group. The Bonar scales of the histological analyses were significantly higher in the paralysis group (total score=7.04±0.61) than the sham group (total score=0) (p<0.0001). If neuropathy of proximal to the suprascapular nerve, such as cervical spine or brachial plexus lesion, exists, weakness and degeneration of the rotator cuff tendon and stiffness of the rotator cuff muscle develop. Neuropathy is likely a cause of rotator cuff tears.

High-resolution nerve ultrasound and magnetic resonance neurography as complementary neuroimaging tools for chronic inflammatory demyelinating polyneuropathy.

Background:We present a clinical, electrophysiological, sonographical and magnetic resonance neurography (MRN) study examining the complementary role of two neuroimaging methods of the peripheral nervous system for patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Furthermore, we explore the significance of cross-sectional area (CSA) increase through correlations with MRN markers of nerve integrity.Methods:A total of 108 nerve segments on the median, ulnar, radial, tibial and fibular nerve, as well as the lumbar and cervical plexus of 18 CIDP patients were examined with high-resonance nerve ultrasound (HRUS) and MRN additionally to the nerve conduction studies.Results:We observed a fair degree of correlation of the CSA values for all nerves/nerve segments between the two methods, with a low random error in Bland–Altman analysis (bias = HRUS-CSA − MRN-CSA, −0.61 to −3.26 mm). CSA in HRUS correlated with the nerve T2-weighted (nT2) signal increase as well as with diffusion tensor imaging parameters such as fractional anisotropy, a marker of microstructural integrity. HRUS-CSA of the interscalene brachial plexus correlated significantly with the MRN-CSA and nT2 signal of the L5 and S1 roots of the lumbar plexus.Conclusions:HRUS allows for reliable CSA imaging of all peripheral nerves and the cervical plexus, and CSA correlates with markers of nerve integrity. Imaging of proximal segments as well as the estimation of nerve integrity require MRN as a complementary method.

Chapter 17 - Plexus and peripheral nerve metastasis

Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.

Ultrasound guided superficial cervical plexus block versus greater auricular nerve block for postoperative tympanomastoid surgery pain: A prospective, randomized, single blind study.

The aim of the study was to investigate the effect of ultrasound guided superficial cervical plexus (SCP) block versus greater auricular nerve (GAN) block for on postoperative tympanomastoid surgery analgesia. In this prospective, randomized, single-blind study, a total of 50 patients aged between 25 and 70 years, those who were in the American Society of Anesthesiologists I-II class and underwent tympanomastoid surgery were included in the study. Patients were randomized to either Group Y: intravenous patient-controlled analgesia tramadol (IV PCA) + SCP block; n=25 and Group G: IV PCA + GAN block; n=25. Postoperative pain was evaluated at the 2nd, 6th, 12nd, and 24th hours using the Visual Analogue Scale (VAS) and postoperative 6th, 12nd, and 24th hour follow-up results were evaluated to identify the quantity of tramadol use. The VAS scores at all measures time were found to be no statistically significant difference between groups (p>0.05). The amounts of PCA tramadol consumption at all measures time were significantly lower in Group Y than in Group G (p<0.05). The results of this study have indicated that SCP and GAN blocks can be used for pain control after tympanomastoid surgery. We believe that the only disadvantage of SCP block application with lower amounts of tramadol use is that the complications that can occur are more serious than those that can occur in GAN application.

Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine.

Background:The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine.Purpose:The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery.Methods:This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes.Results:In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively.Conclusions:Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.