Superficial Cervical Plexus Research Articles

The Superficial Cervical Plexus Block with the Auriculotemporal Nerve Block for Breaking the Refractory Pain Cycle of Malignant Otitis Externa and Skull Base Meningitis

Abstract Pain can be a severe and distressing symptom in conditions such as malignant otitis externa (MOE) with the associated skull base meningitis and even more following the debridement surgeries done for the same. It can be refractory to conventional therapies, including weak opioids, nonsteroidal anti-inflammatory drugs, and antineuropathic medications. Breaking this cycle of pain is very important in such cases to achieve good pain control and treat the psychological distress of the patient. Since there is a lack of literature for achieving satisfactory pain control in such cases, we successfully adopted a novel approach to break the pain cycle by employing the superficial cervical plexus block and auriculotemporal nerve (ATN) nerve block as the area of pain was in the distribution of these two nerves.

Effectiveness and safety of electroacupuncture analgesia in controlling intraoperative pain and hemodynamics during total thyroidectomy: A randomized controlled trial

ObjectiveTo evaluate the effectiveness and safety of electroacupuncture in conjunction with additional medications in providing analgesia and stabilizing hemodynamic parameters during total thyroidectomy. MethodsThis randomized controlled trial included 100 patients who underwent a total thyroidectomy between October 2022 and October 2023 at the Vietnam National Hospital of Acupuncture. The patients were randomized into two groups. The electroacupuncture analgesia (EA) group received EA stimulation at five acupuncture points: Hegu (LI 4), Neiguan (PC 6), Shuitu (ST 10), Quepen (ST 12), and Yifeng (SJ 17), while the control group received a bilateral superficial cervical plexus block. Primary outcomes included the level of analgesia and perioperative vital signs in both groups. Additionally, pain thresholds and serum β-endorphin levels were measured before and after electroacupuncture in the EA group. ResultsComplete analgesia (Level A) was attained in 86% and 76% of the patients in the EA and control groups, respectively, with no significant difference between the two groups (P = 1.00). In the EA group, the mean pain threshold after receiving EA doubled (648.7 (77.4) g/s vs. 305.3 (45.3) g/s, P < .001), and the mean serum β-endorphin level increased by approximately 13.5 pg/mL (P < .001). All patients remained hemodynamically stable throughout the surgery. ConclusionEA, in conjunction with additional medications that stimulate five acupuncture points, LI 4, PC 6, ST 10, ST 12, and SJ 17, was well tolerated and effectively maintained a suitable level of analgesia and hemodynamic stability during total thyroidectomy.

Blok Pleksus Servikalis Superfisialis pada Insisi Abses Submandibula

This case study explores the use of bilateral superficial cervical plexus block as a regional anesthesia method in a 44-year-old male patient with a submandibular abscess. The patient, who has comorbidities of type 2 diabetes mellitus, renal insufficiency, and grade 1 obesity, underwent a 60-minute abscess drainage incision operation. This technique was chosen based on patient factors and the medical team's preference, avoiding the risks associated with general anesthesia. Lidocaine 2% at 6cc per side was used, demonstrating the effectiveness of the cervical plexus block in this procedure and others such as lymph node dissection and laceration repair. The study confirms that regional anesthesia guided by ultrasound is a quick, resource-efficient, and safe option, with the potential to avoid improper analgesic dosing. For longer procedures, local anesthetics like ropivacaine or bupivacaine can be utilized. The main conclusion is that the superficial cervical plexus block is an effective and safe alternative for anesthesia in certain neck procedures.

Effect of ultrasound-guided bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial.

Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.

Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery.

Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging. This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation. This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: One receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student's t-tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05. A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's t-test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA. The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.

Modern approaches to perioperative management of patients undergoing carotid endarterectomy in acute period of ischemic stroke

This article presents the Moscow Botkin Hospital experience of using combination of general and superficial cervical plexus regional anesthesia during carotid endarterectomy performed in patients in the acute period of atherothrombotic genesis ischemic stroke. The result of reliable antinociceptive protection of the body from the activation of the sympatho-adrenal system against the background of surgical manipulations was the prevention of episodes of critical hypertension and ensuring normalization of systemic hemodynamics. By reducing the need for opioids, patients’ awakening is accelerated, and their time in the operating room is minimized. In addition, the time of necessary observation in the intensive care unit and the need for anesthesia at the immediate postoperative period, is also reduced. The above factors, as well as a multidisciplinary approach to the patient, allowed not only to provide reliable prevention of recurrent vascular incidents in the acute period of ischemic stroke, but also to improve the neurological outcomes.

Combined interscalene, superficial cervical plexus and thoracic intertransverse process blocks for surgical anaesthesia of the shoulder disarticulation.

Combined interscalene, superficial cervical plexus and thoracic intertransverse process blocks for surgical anaesthesia of the shoulder disarticulation.

Combined interscalene brachial plexus block and superficial cervical plexus block for shoulder disarticulation surgery in a terminal cancer patient.

Combined interscalene brachial plexus block and superficial cervical plexus block for shoulder disarticulation surgery in a terminal cancer patient.

Efficacy of Dexamethasone versus Dexmedetomidine as an Adjuvant to Bupivacaine for Bilateral Superficial Cervical Plexus Block in Thyroid Surgeries: A Randomised Clinical Trial

Introduction: Thyroid surgeries are among the most frequently performed endocrine surgeries globally. Pain control is one of the many challenges faced by perioperative physicians in postthyroid surgery patients; if, left untreated, it can progress to chronic pain. Regional anaesthesia, such as Bilateral Superficial Cervical Plexus Block (BSCPB), can provide excellent analgesia in the initial postoperative period without the side effects of systemic analgesics. Aim: To assess postoperative pain using Visual Analogue Scale (VAS) scores at various intervals upto 24 hours postoperatively and to evaluate the duration of the superficial cervical plexus block. Secondary objectives include assessing intraoperative haemodynamic stability, analgesic consumption, and blockrelated complications. Materials and Methods: This randomised double-blinded clinical trial was conducted in the Department of Anaesthesiology at a teritary care centre, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre in Vijayapur, Karanataka, India, from April 2023 to March 2024 on 74 American Society of Anaesthesiologists (ASA) grades I-II patients undergoing elective thyroid procedures were randomly assigned to two groups: Group Dexmedetomidine (DexD) (n=37), which received US-guided BSCPB with 10 mL of 0.5% bupivacaine and 25 mcg of dexmedetomidine on both sides; and Group Dexamethasone (DexA) (n=37), which received USguided BSCPB with 10 mL of 0.5% bupivacaine and 4 mg of dexamethasone on both sides. Intraoperative blood pressure, Heart Rate (HR), and Mean Arterial Pressure (MAP) were measured at predefined time periods. Postoperative VAS scores were assessed at predefined intervals, along with the time taken for the first analgesic request and the cumulative postoperative analgesic dose consumed. Student’s t-test and Chi-square test were used for data comparison. Results: The mean age in Group DexD was 42.59±8.64 years, and in Group DexA it was 45.40±8.96 years. Group DexD had significantly lower postoperative VAS scores for upto eight hours (2.108 vs. 2.72; p-value=0.0002), and the time before the first rescue analgesia request was significantly longer than that of Group DexA (688.37±55.75 min vs. 593.64±72.56 min; p-value=0.001). The total postoperative analgesic utilisation in the first 24 hours was significantly lower in Group DexD compared to Group DexA (81.08±20.754 mg vs. 104.17±44.921 mg; p-value=0.006). Group DexA experienced a lower incidence of nausea (p-value=0.002) and vomiting (p-value=0.001) in the postoperative period. Conclusion: Dexmedetomidine performed better than dexamethasone when added to bupivacaine for BSCPB for pain management during the postoperative period in patients undergoing thyroid surgical procedures. However, when added, dexamethasone has the advantage of reducing nausea and vomiting in the postoperative period.

Anaesthetic Management of a Patient with Guillain-Barré Syndrome undergoing Proximal Humerus Fracture Surgery: A Case Report

Guillain-Barré Syndrome (GBS) is an autoimmune disorder which can present in acute and chronic forms. It is an inflammatory demyelinating polyneuropathy. These patients pose potential perioperative risks of autonomic dysfunction and respiratory muscle weakness. The current case report shows a 66-year-old female with a history of a fall at home eight days prior to surgery, diagnosed with a right-sided proximal humerus fracture. The patient was a diagnosed case of GBS and hypertension since five years. For GBS, she had a history of Intensive Care Unit (ICU) admission for both upper and lower limb muscle weakness and breathlessness. She recovered with treatment of Intravenous Immunoglobulin (IVIg) and oxygen therapy. The weakness improved gradually over time but did not fully recover. The patient continued to have weakness in both lower and upper limbs prior to surgery. The patient underwent Joshi’s External Stabilising System (JESS) fixation surgery for the right proximal humerus fracture. Ultrasound-guided (USG) interscalene and superficial cervical plexus block were performed in view of pre-existing muscle weakness and to reduce the requirement of postoperative ventilator support. The intraoperative course was uneventful. The patient’s sensory and motor power returned to the same prior to surgery after the block’s effects subsided.

Comparison of the effectiveness of peroperative anesthesia of deep and superficial cervical plexus block with conventional approach or ultrasonography for carotis endarterectomy

Comparison of the effectiveness of peroperative anesthesia of deep and superficial cervical plexus block with conventional approach or ultrasonography for carotis endarterectomy

Adding Two Doses of Dexmedetomidine in Bilateral Superficial Cervical Plexus Block for Thyroidectomy.

Adding Two Doses of Dexmedetomidine in Bilateral Superficial Cervical Plexus Block for Thyroidectomy.

Vital Role of an Anaesthesiologist in Rendering Safe Anaesthesia in a Case of Parotid Tumor Resection with Obesity: A Case Report

Parotid pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. Slowly progressing asymptomatic swelling is the usual presentation of the tumor. Surgical excision of the tumor mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve. We describe here, a case of an obese male patient who was posted for parotid tumor resection under general anesthesia supplemented with superficial cervical plexus block whilst monitoring both muscle relaxation and nerve integrity.

Early observations with an ERAS pathway for thyroid and parathyroid surgery: Moving the goalposts forward

BackgroundEnhanced recovery after surgery pathways have become the standard of care in various surgical specialties. In this study, we discuss our initial experience with a staged enhanced recovery after surgery pathway in endocrine surgery and assess the impact of this pathway on select perioperative outcomes and unanticipated admissions. MethodsWe collected information regarding all thyroid/parathyroid surgeries performed by endocrine surgeons at our institution before and after the implementation of the multi-intervention enhanced recovery after surgery pathway. We compared relevant outcomes for all cases 1 year before (n = 479) and 1 year after (n = 166) implementation of the pathway. We also compared outcomes between enhanced recovery after surgery patient groups with varying levels of enhanced recovery after surgery compliance. ResultsEnhanced recovery after surgery was associated with a significant decrease in total length of stay (9.2 vs 7.5 hours, P < .0001). Whereas there was no significant decrease in all-cause unanticipated postoperative admissions, there was a decrease in patient-initiated admissions in the Enhanced recovery after surgery group. There was also a significant decrease in mean postoperative morphine milligram equivalents (14.4 vs 16.2 vs 24.8, P = .0015), average daily morphine milligram equivalents (25.6 vs 45.6 vs 53, P < .0001), and average daily pain scores (1.89 vs 2.38 vs 2.74, P = .0045) in the Enhanced recovery after surgery group (particularly with increasing Enhanced recovery after surgery compliance). There were no significant differences in the requirement for postoperative antiemetics or in the post-anesthesia care unit length of stay. ConclusionThis study demonstrates a significant benefit from Enhanced recovery after surgery pathways for thyroidectomies and parathyroidectomies, even with initial data and a staggered roll-out plan. Further directions include a follow-up study once we reach a higher level of institutional compliance with all components of the Enhanced Recovery After Surgery pathway and a prospective trial to identify the relative significance of different portions of the Enhanced Recovery after Surgery pathway, particularly the superficial cervical plexus block.

Single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery: a prospective randomized comparative trial

BackgroundTo investigate the effects of a single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery.MethodsForty patients, 25 males and 15 females, aged 18–85 years with ASA class I or II underwent unilateral clavicular fracture internal fixation. The patients were randomly divided into a superficial cervical plexus block group (group S, n = 20) and a superficial cervical fascia block group (group F, n = 20). First, the brachial plexus of the intermuscular sulcus of all patients was blocked with an ultrasound-guided injection of one injection with 15ml 0.33% ropivacaine 15ml in both groups. Second, the superficial cervical plexus was blocked by another injection of 5-8ml 0.33% ropivacaine in group S, and the superficial cervical fascia was blocked by an injection with 5-8ml 0.33% ropivacaine in Group F. We evaluated operation time, onset time of anaesthesia, effective time and the grades of nerve block effect in the two groups. Additionally, we evaluated the incidences of local anaesthetic poisoning, hoarseness, dyspnoea, and postoperative nausea and vomiting, and the number of patients requiring remedial analgesia within 24 h. Repeated measurements were analysed by repeated data analysis of variance, and count data were compared by the χ2 test. A P value < 0.05 was considered statistically significant.ResultsThe operation time and onset time in Group F were significantly shorter than those in group S (P < 0.05); the effect of intraoperative block was better than that in group S (P < 0.05), and the effective time was significantly longer in group F than in group S (P < 0.05). However, no severe case of dyspnoea, local anaesthetic poisoning or hoarseness after anaesthesia occurred in either of two groups. There was no significant difference in the rate of postoperative salvage analgesia or that of postoperative nausea and vomiting between the two groups.ConclusionsThe application of the single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery is beneficial because it shortens the operation time, has a faster onset, produces a more effective block and prolongs the longer analgesia time.Trial registrationChinese Clinical Trial Registry- ChiCTR2200064642(13/10/2022).

Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment.

Thermage is a monopolar radiofrequency (RF). It has become an indispensable part of facial and body youthful methods. Although the current device is constantly improving in epidermal cooling techniques and even automatically measures the local impedance value, applying surface anesthesia can take some of the pain away caused by thermage, and the patient's severe pain in the jaw and neck areas is still difficult to resolve. The author describes how he uses the combination of the buccal nerve block (BNB) and the superficial cervical plexus block (SCPB) to improve the comfort of the patient's face and neck treatment of patients. It can improve the quality, elasticity, and texture of the skin. According to the author's knowledge of oral and maxillofacial surgery, the combination of BNB and SCPB is applied to the neck and facial analgesia. Combining the BNB and SCPB effectively provides facial and neck anesthesia. The BNB in this technique provides pain relief to the facial skin in the mandibular area and SCPB offers pain relief to the skin of the neck. RF facial rejuvenation treatment often involves the junction of the face and neck to improve the contour of the mandibular margin. Therefore, Whether the RF treatment is aimed at the face or neck, or the treatment is performed simultaneously, we advocate the block both of the buccal nerve and the superficial cervical plexus nerves to achieve perfect analgesia. Still, the dosage of anesthetic medication for the nerve block can be adjusted according to the treatment area. We applied these two nerve blocks and their combination to improve skin laxity with RF therapy for the first time.

The analgesic effects of bilateral superficial cervical plexus block in thyroid surgery: A systematic review and meta-analysis.

Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed. The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use. A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption (P < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV (P = 0.02). BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.

A Randomized Comparison between Classical Landmark-based and Ultrasound-guided Right Superficial Cervical Plexus Block in Attenuating Postlaparoscopic Shoulder Pain under Subarachnoid Anesthesia

ABSTRACT Background: Postlaparoscopic shoulder pain is believed to be due to phrenic nerve involvement, with an incidence of 35%–80%. Classical landmark-based right superficial cervical plexus block (SCPB) has been utilized to alleviate postlaparoscopic shoulder pain. However, there is no possibility of phrenic nerve blockade with subcutaneously deposited injectate in landmark-based SCPB. Therefore, we hypothesized that the local anesthetic injectate in the sternocleidomastoid-scalene intermuscular fascial plane under ultrasound guidance is paramount in achieving phrenic nerve blockade. The main objective was to evaluate the effect of ultrasound-guided right SCPB in decreasing postlaparoscopic shoulder pain compared to conventional landmark-guided SCPB. Methods: In this prospective randomized trial, 79 adult patients reported for laparoscopic surgeries under spinal anesthesia were randomly divided into groups; A and B. Group A patients received intermediate approach to SCPB with 10 ml of 0.5% bupivacaine under ultrasound guidance. Group B patients received SCPB using a classical landmark-based approach. The incidence of intraoperative and postoperative shoulder pain and other adverse effects were noted. Results: Intraoperative shoulder pain was significantly less in Group A than in Group B (5% vs. 43.5%, P &lt; 0.001). The postoperative shoulder pain was also significantly reduced in Group A than in Group B (5% vs. 28.2%, P = 0.013). There were no instances of major adverse effects. Conclusion: We conclude that the ultrasound-guided injectate in the sternocleidomastoid-scalene intermuscular space deeper to investing layer but superficial to the prevertebral layer of the deep cervical fascia is central to providing superior shoulder pain relief in patients undergoing laparoscopic surgery under spinal anesthesia than the classical landmark-based SCPB.

Role of Bilateral ultrasound guided superficial cervical plexus block as a part of enhanced recovery after thyroid surgery

Role of Bilateral ultrasound guided superficial cervical plexus block as a part of enhanced recovery after thyroid surgery

SCPNB is an adjuvant to local anaesthesia for maxillofacial surgical practice.

The superficial cervical plexus nerve block [SCPNB] procedure is frequently used throughout head and neck surgery because it is simple to learn and has a low rate of complications. The investigation of this method might produce superior outcomes in treating frequent maxillofacial disorders including mandibular fractures and infections of the odontogenic region. The SCPNB is known to play a part in the medical evacuation of head and neck abscesses, the excision of superficial diseases in the perimandibular region, and the therapy of mandibular fracture, despite the dearth of research in this area. Considering this background, it was expected that the SCPNB might be helpful as an adjuvant to regional anaesthesia in maxillofacial surgery. The purpose of this study was to assess the effectiveness of the SCPNB in the treatment of mandibular fractures and infectious diseases in the perimandibular area. 48 patients with either submandibular space infections or mandibular injuries who were anticipated for surgical procedure under regional anaesthesia participated in a prospective randomized clinical study (eg, inferior alveolar nerve block, long buccal nerve block). Administering a combination of a local infiltration and regional anaesthesia was used as the control group. Regional anaesthesia and a SCPNB were administered to the intervention class. The following factors were examined: pain, anaesthesia's duration and onset, waiting period before initial analgesic demand, pulse rate, and blood pressure. The unpaired t-test was used to compare groups. Multiple variables ANOVA (for more than two observations) was used for intragroup analysis, accompanied by a post-hoc analysis of variance. In aspects of intra - operative pain at thirty minutes, time required of anaesthesia, intraoperative anesthetic necessity, duration until first analgesic recommendation, and intra - operative diastolic arterial blood pressure at ten minutes, the SCPNB group demonstrated a substantial (P ≤.01) improved performance. It can be concluded that the use of a regional anaesthetic approach in conjunction with a SCPNB is a good substitute to localized infiltration for patients having surgery for fracture of mandible and perimandibular area infections.