Deep Cervical Plexus Block Research Articles

Pharmacokinetics of levobupivacaine 0.5% after superficial or combined (deep and superficial) cervical plexus block in patients undergoing minimally invasive parathyroidectomy

Study ObjectiveTo evaluate the pharmacokinetic profile of 0.35 mL/kg of 0.5% levobupivacaine during superficial and combined (deep and superficial) cervical plexus block (CPB) in patients undergoing minimally invasive parathyroidectomy. DesignProspective randomized study. SettingOperating theater of a university hospital. Patients12 ASA physical status II and III patients (11 women and 1 man), scheduled for minimally invasive parathyroidectomy. InterventionsSeven and 5 patients were randomly assigned to receive either superficial or combined CPB, respectively. The superficial CPB was performed with an injection of 0.35 mL/kg of 0.5% levobupivacaine subcutaneously along the posterior border of the sternocleidomastoid muscle and deeper on its medial surface. The combined CPB was initiated by the deep block at the C3 level vertebra by injecting 0.2 mL/kg of 0.5% levobupivacaine, followed by the superficial block with an injection of the remaining 0.15 mL/kg. After completion of the block, venous blood was sampled at the intervals of 5, 10, 15, 20, 30, 45, and 60 minutes. Measurements and Main ResultsVenous plasma concentrations were measured using gas chromatography-mass spectroscopy. Mean ± SD of maximal concentrations of levobupivacaine was 0.58 ± 0.41 mg/L in group superficial and 0.52 ± 0.28 mg/L in group combined (P = 0.71). The median (range) time required to reach the maximal concentrations was 30 minutes (20-30 min) in group superficial and 20 minutes (15-30 min) in group combined (P = 0.45). The areas under the drug concentration/time curve (AUC10-60) were also similar in both groups. No signs of central nervous system or cardiovascular toxicity or other untoward events were observed in any patient. ConclusionWith the given dose regimen, levobupivacaine plasma concentrations were within safe ranges.

Demonstration of the Spread of Injectate With Deep Cervical Plexus Block: A Case Series

The authors conducted a scanographic study in order to characterize the local anesthetic spread of injectate resulting from a single-injection technique of deep cervical plexus block. Six consecutive American Society of Anesthesiologists II and III patients scheduled for elective carotid endarterectomy under regional anesthesia were enrolled. Deep cervical plexus block was placed via an anterolateral approach using a nerve stimulator to guide the injection on contact with the levator scapulae nerve. With specific contractions evoked at a stimulating current intensity <or=0.5 mA, a 40-mL mixture containing local anesthetics and iopamidol was injected. Thirty minutes after the block was placed, sensory and motor neural blockade was evaluated, and a helicoidal scanner of the head-neck and upper thorax was completed. Sequential cross sections spaced at 5 mm were performed from the base of the skull down to T1. A 3-dimensional volume-rendering technique was used to characterize spread of injectate, which calculated volume. All patients completed C2-C4 dermatomal sensory blockade. None of the patients experienced anesthesia of the C8 and T1 dermatomes. The spread of injectate extended in a cephalocaudal direction from C1 to C7; its wider dimensions were systematically observed at the C3-C4 level. Fascia of the carotid sheath and sternocleidomastoid muscle limited the anterior spread of injectate. The trapezius limited lateral and posterior diffusion of injectate. Spread of injectate had a large volume exceeding twice that of the injectate. It has roughly a hemi cylinder shape with both ends stretched toward C1 and C7. The authors showed that deep cervical plexus block was associated with a wide spread of injectate. The data show that the spread of injectate is enclosed within to the prevertebral layer of the deep cervical fascia.

Demonstration of the Spread of Injectate With Deep Cervical Plexus Block

Demonstration of the Spread of Injectate With Deep Cervical Plexus Block

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

Staged Anesthesia for Combined Carotid and Coronary Artery Revascularization: A Different Approach

Combined coronary artery bypass graft (CABG) surgery and carotid endarterectomy (CEA) are performed in an attempt to reduce the risk of postoperative stroke after CABG surgery in patients with significant or symptomatic carotid artery stenosis. The choice between regional and general anesthesia for CEA is still under debate. Regional anesthesia offers an excellent monitoring technique of the neurologic status of the awake patient during carotid clamping. In an attempt to improve monitoring of the neurologic status and avoid the use of temporary shunting in patients undergoing the combined procedure, a different approach is described combining regional anesthesia for CEA followed immediately by general anesthesia for CABG surgery. Prospective nonrandomized case series. University hospital. Twenty patients scheduled for combined CEA and CABG surgery underwent a "staged" anesthetic approach from January to December 2004. Pulmonary, femoral artery, and urinary catheters were inserted under local anesthesia. A deep cervical plexus block was then performed and supplemented by a superficial cervical plexus block. The patient was draped for standard combined CEA and CABG surgery. CEA was then performed using standard techniques. Without altering the surgical field, general anesthesia was given and endotracheal intubation performed following the successful CEA. Coronary revascularization was then completed. CEA and CABG surgery were completed successfully in all patients. There was no need for conversion from local to general anesthesia. Endotracheal intubation was easily performed in all patients. There was no hospital mortality in this series. No neurologic events were observed during the CEA. A reversible ischemic stroke, ipsilateral to the CEA, occurred postoperatively on awakening from CABG surgery in 1 patient. This staged anesthetic approach for combined CABG and CEA surgery is an alternative in this complex subset of patients.

Regional anaesthesia in carotid endarterectomy: comparison between superficial and deep cervical plexus block in patients with coronary artery disease

Regional anaesthesia in carotid endarterectomy: comparison between superficial and deep cervical plexus block in patients with coronary artery disease

Ultrasound Guided Deep Cervical Plexus Block

We describe a new technique for achieving a deep cervical plexus block using a portable vascular access ultrasound scanner (Site-Rite II, Bard Access Systems, Pittsburgh, PA).

Cervical Plexus Block Helps in Diagnosis of Orofacial Pain Originating from Cervical Structures

Headache associated with cervical lesions is called cervicogenic headache and involves the occiput but not the orofacial region. However, patients occasionally present with orofacial pain accompanied by neck symptoms. This study investigates whether orofacial pain can originate from the neck and whether cervical plexus block can help in diagnosis. We enrolled eight patients suffering from chronic orofacial pain that had not been relieved by dental treatment. Radiographic and magnetic resonance imaging revealed abnormal findings in the neck in seven of them. To identify the origin of the orofacial pain, we firstly blocked peripheral sensory input from the oral cavity and surrounding tissues, followed by that from deep cervical structures. We injected local anesthetics around the painful orofacial region, then to the tender points in the masticatory and superficial cervical muscles (trigger point injection), and consequently around the cervical plexus. Pain was assessed using a pain relief score compared with pre-treatment control values. Local anesthesia in the painful oral region provided insufficient relief whereas trigger point injection significantly relieved pain. The amount of pain relief generated by the deep cervical plexus block was more significant than that produced by any other procedures. We conclude that certain types of orofacial pain originate from cervical structures and that a deep cervical plexus block can be helpful in differentially diagnosing such pain.

A prospective, randomised comparison of superficial versus combined (deep and subcutaneous) cervical plexus block with levobupivacaine for minimally invasive parathyroidectomy (MIP)

A prospective, randomised comparison of superficial versus combined (deep and subcutaneous) cervical plexus block with levobupivacaine for minimally invasive parathyroidectomy (MIP)

The number of injections does not influence absorption of bupivacaine after cervical plexus block for carotid endarterectomy

Study ObjectiveTo investigate the efficacy and kinetics of bupivacaine when used for deep cervical plexus block (CPB), using either a single-injection or multiple-injections technique. DesignProspective, randomized, double-blind study. SettingOperating room of a university hospital. PatientsTwenty-four adult patients (16 men, 8 women) scheduled for carotid endarterectomy. InterventionsPatients were randomly assigned to receive CPB either by a single injection or after 3 injections. Patients in the multiple-injections group received a total dose of 15 mL of 0.5% bupivacaine (5 mL each deposited at C2, C3, and C4 over 2 minutes). Patients in the single-injection group received a single 15-mL injection of 0.5% bupivacaine. After the deep CPB, a superficial CPB was performed with 20 mL of 0.5% bupivacaine in all patients. MeasurementsAn anesthesiologist and a surgeon graded the success of the block. Arterial plasma concentrations of bupivacaine were measured using liquid chromatography–mass spectroscopy. Main ResultsNo significant differences were seen between the 2 groups with respect to the mean peak concentration of bupivacaine (single injection 2314 ± 1385 ng/mL vs multiple injections 2255 ± 1105 ng/mL) or time to reach the maximal concentration (time to maximum concentration [single injection 12.1 ± 7.2 minutes vs multiple injections 12.5 ± 3.9 minutes]). Furthermore, there were no significant differences in mean block scores between the single-injection and the multiple-injections groups, evaluated either by the anesthesiologists or the surgeon. ConclusionsThe results of this study showed that the absorption of bupivacaine is independent of the number of injections after CPB, and that anesthesia for carotid endarterectomy may be accomplished successfully using either technique.

Respiratory Distress after a Deep Cervical Plexus Block

Respiratory Distress after a Deep Cervical Plexus Block

Acute respiratory failure after deep cervical plexus block for carotid endarterectomy as a result of bilateral recurrent laryngeal nerve paralysis

We report about a case of acute respiratory distress (73-year-old female), which occurred minutes after a deep cervical plexus block (40 ml ropivacaine 0.5%) for carotid endarterectomy (CEA) and required immediate endotracheal intubation of the patient's trachea and consecutive mechanical ventilation. Subsequently, CEA was performed under general anaesthesia (TIVA) with continuous monitoring by somatosensory-evoked potentials. After a period of 14 hours, the endotracheal tube could be removed, the patient being in fair respiratory, cardiocirculatory and neurological conditions. Retrospectively, acute respiratory distress was caused by a combination of ipsilateral plexus blockade-induced and pre-existing asymptomatic contralateral recurrent laryngeal nerve (RLN) paralysis confirmed by a postoperative ENT-check and related to previous thyroid surgery more than 50 years ago. RLN paralysis, often being asymptomatic, represents a typical complication of thyroid and other neck surgery with reported incidences of 0.5-3%. Therefore, a thorough preoperative airway check is advisable in all patients scheduled for a cervical plexus block. Particularly in cases with a history of respiratory disorders or previous neck surgery a vocal cord examination is recommended, and the use of a superficial cervical plexus block may lower the risk of respiratory complications. This may prevent a possibly life-threatening coincidence of ipsilateral plexus blockade-induced and pre-existing asymptomatic contralateral RLN paralysis.

A comparison of superficial versus deep cervical plexus block for carotid endarterectomy: a prospective, randomized study

A comparison of superficial versus deep cervical plexus block for carotid endarterectomy: a prospective, randomized study

A comparison of superficial versus deep cervical plexus block for carotid endarterectomy: a prospective, randomized study

A comparison of superficial versus deep cervical plexus block for carotid endarterectomy: a prospective, randomized study

Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block

During carotid endarterectomy under regional anaesthesia, patients often require medication to control haemodynamic instability and to provide sedation and analgesia. Propofol and remifentanil are used for this purpose. However, the benefits, side-effects, and optimal dose of these drugs in such patients are unclear. Sixty patients were included in a prospective, randomized, single blinded study. All patients received a deep cervical plexus block with 30 ml ropivacaine 0.75% and were randomized to receive either remifentanil 3 micro g kg(-1) h(-1) or propofol 1 mg kg(-1) h(-1). The infusions were started after performing the regional block and were stopped at the end of surgery. Arterial pressure, ECG, ventilatory rate, and Pa(CO(2)) were measured continuously and recorded at predetermined times. Twenty-four hours after surgery, patient comfort, and satisfaction were also evaluated. In three patients, the infusion of remifentanil had to be stopped because of severe respiratory depression or bradycardia. No significant differences were found between the two groups in haemodynamic variables or sedative effects, but there was a significantly greater decrease in ventilatory frequency and increase in Pa(CO(2)) in the remifentanil group. The patient's subjective impressions and pain control were excellent in both groups. As a result of the higher incidence of adverse respiratory effects with remifentanil and similar sedative effects, propofol is preferable for sedation during cervical plexus block in elderly patients with comorbid disease at the dosage used.

The Analgesic Efficacy of Bilateral Combined Superficial and Deep Cervical Plexus Block Administered Before Thyroid Surgery Under General Anesthesia

In this study we evaluated the analgesic efficacy of combined deep and superficial cervical plexus block in patients undergoing thyroidectomy under general anesthesia. For this purpose, 39 patients undergoing elective thyroid surgery were randomized to receive a bilateral combined deep and superficial cervical block (14 mL per side) with saline (Group 1; n = 13), ropivacaine 0.5% (Group 2; n = 13), or ropivacaine 0.5% plus clonidine 7.5 microg/mL (Group 3; n = 13). Deep cervical plexus block was performed with a single injection (8 mL) at the C3 level. Superficial cervical plexus block consisted of a subcutaneous injection (6 mL) behind the lateral border of the sternocleidomastoid muscle. During surgery, the number of additional alfentanil boluses was significantly reduced in Groups 2 and 3 compared with Group 1 (1.3 +/- 1.0 and 1.1 +/- 1.0 vs 2.6 +/- 1.0; P < 0.05). After surgery, the opioid and non-opioid analgesic requirements were also significantly reduced in Groups 2 and 3 (P < 0.05) during the first 24 h. Except for one patient in Group 3, who experienced transient anesthesia of the brachial plexus, no side effect was noted in any group. We conclude that combined deep and superficial cervical plexus block is an effective technique to alleviate pain during and immediately after thyroidectomy. Combined deep and superficial cervical plexus block is an effective technique to reduce opioid requirements during and after thyroid surgery.

The Analgesic Efficacy of Bilateral Combined Superficial and Deep Cervical Plexus Block Administered Before Thyroid Surgery Under General Anesthesia

The Analgesic Efficacy of Bilateral Combined Superficial and Deep Cervical Plexus Block Administered Before Thyroid Surgery Under General Anesthesia

Insertion of vagal nerve stimulator using local and regional anesthesia

Background Vagal nerve stimulation (VNS) is a valuable therapy for patients with intractable epilepsy. Placement of a vagal nerve stimulator typically requires general anesthesia, which frequently interrupts anticonvulsant therapy. Insertion of the stimulator using regional/local anesthesia may offer the advantages of continuity of anticonvulsant therapy and implantation in the outpatient setting. Methods We retrospectively compared the first 10 consecutive patients undergoing VNS implantation under general anesthesia with the first 12 consecutive patients undergoing VNS implantation under regional/local anesthesia. Patients for the regional/local anesthesia were selected on the basis of their ability to cooperate and follow commands. Regional anesthesia for implantation of the VNS leads was achieved by performing superficial and deep cervical plexus blocks. A local anesthetic field block of a small area of the posterior chest provided anesthesia for insertion of the generator. Results All of the patients undergoing regional/local anesthesia completed the procedure without difficulty and on an outpatient basis. None complained of discomfort, sedation, nausea, or vomiting and none had seizures in the perioperative period. These results contrasted with the group that underwent general anesthesia ( n = 10), who had an 80% incidence of nausea and vomiting and a 30% incidence of postoperative seizures. Conclusion VNS implantation under regional/local anesthesia is proficiently performed as an outpatient procedure with minimal postoperative side effects.

Remifentanil conscious sedation during regional anaesthesia for carotid endarterectomy: rationale and safety.

to prospectively evaluate the safety and efficacy of remifentanil during regional anaesthesia for carotid endarterectomy. twenty-eight consecutive patients underwent carotid endarterectomy with combined superficial and deep cervical plexus block supplemented with continuous intravenous 0.04 microg.kg(-1).min(-1)remifentanil infusion. Depth of sedation was monitored using the Observer's Assessment of Alertness/Sedation Scale (OAA/S). The degree of pain, discomfort and anxiety was self-assessed by the patients using a horizontal visual analogue scale. all patients experienced adequate comfort and analgesia. No local anaesthetic supplementation was necessary. No patient had a OAA/S score lower than 4 (with 5=awake/alert to 1=asleep). Respiratory depression did not occur. Selective shunting was required in four cases. No patient was converted to general anaesthesia. There were no permanent neurological deficits, cardiopulmonary complications or deaths. remifentanil as a supplement to regional anaesthesia for carotid endarterectomy, provides comfort and analgesia without hampering mental status evaluation.

Severe dental pain during carotid endarterectomy under cervical plexus block

CERVICAL PLEXUS BLOCK anesthesia is frequently used for carotid endarterectomy (CEA). It facilitates cerebral function monitoring and provides perioperative cardiovascular stability. 1 David A Zvara MD Regional anesthesia is the best technique for CE. J Cardiothorac Vasc Anesth. 1998; 12: 111-114 Abstract Full Text PDF PubMed Scopus (13) Google Scholar The combination of a deep and superficial cervical plexus block should provide adequate analgesia for the operation. 2 Davies MJ Silbert BS Scott DA et al. Superficial and deep cervical plexus block for carotid artery surgery: A prospective study of 1000 blocks. Reg Anesth. 1997; 22: 442-446 Crossref PubMed Google Scholar In some cases, however, patients experience discomfort in the surgical field during the incision of the skin or the dissection of the carotid sheath. This discomfort is usually relieved by local infiltration. An unreported referral of pain to the lower jaw and the dental area, encountered in 2 cases during CEA, is described.