Transcript 3 MB - cervical plexus mgmc - Anesthesia Slides, Presentations and

Cervical plexus
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu),
Dip. Diab. DCA, Dip. Software statistics
PhD (physio),
FICA
Halsted – 1884
• Kappis
• Labat – popularized
• What made it as big hero
• Carotid endarterectomy
Cervical plexus
• Superficial
• and
• Deep
Anatomy or
ANESTHESIA
• In anatomy – there is one cervical plexus
• What is special !!
• The cervical plexus gives all its motor nerves
earlier to be as only sensory nerves later –
• This difference enable us to block the sensory
component which we call it as SCPB
Indications
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Carotid endarterectomy
Lymph node dissections
Plastic repairs (Neck)
Shoulder surgery (supplement brachial
plexus)
• Tracheostomy
• Thyroidectomy
• Parathyroidectomy
Other indications
• Injuries to the ear, neck and clavicular region
• Including clavicular fractures and acromioclavicular dislocations
• Cervicogenic headaches
Alone or as
Supplement
Anatomy
• Spinal nerves emerge from the intervertebral
foramina and pass behind the vertebral artery and
vein in the gutter formed by the anterior and
posterior tubercles of the corresponding transverse
process of the cervical vertebrae.
• Anterior and posterior rami -Ventral – ascending and
descending branches -Loop – plexus – fascial sheath
• Communication with sympathetic chain and cranial N
ANATOMY
Anatomy – superficial
• The superficial cervical plexus (SCP) originates
from the anterior rami of the C2-C4 spinal
nerves and gives rise to 4 terminal branches
• lesser occipital
• greater auricular
• transverse cervical
• supraclavicular nerves
• sensory innervation to the skin and superficial
structures of the anterolateral neck and sections
of the ear and shoulder
Accessory nerve
Distribution of skin anesthesia
Technique of blockade
• Middle of the posterior border
of sternocleido mastoid
muscle
• Face to one side
• Lift the head and valsalva
• SCM prominent with EJV
• Subcutaneous – 5-8 ml both
sides
• Accessory nerve close !!
USG guided
Beware what are below
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Both sides we can do
No motor effects
Alone - difficult for surgeon – no motor block
Less side effects
Accessory !!!
Deep cervical plexus block
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Para vertebral block of C2 C3 C4 nerves !!
Mastoid to chassaignac ( C6) – line
Posterior line – 1 cm
Caudad – 1.5 cm each –
Lower border of mandible – C4
Transverse process hit , withdraw 2 mm , inject
Inject deep to
deep fascia -
• Probe placement for
deep cervical plexus
Other
approaches
Behind carotid sheath
place probe lateral
Trace interscalene groove and deposit
above
Classical -
Needle
TP
Drugs for deep cervical plexus block
Single injection
• Thyroid notch – C4
• Go up by 2 cm
• Give 12-15 ml of local anesthetic
Dangers
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Phrenic nerve block
Vertebral artery
Epidural – no above
Subarachnoid
60 % incidence of phrenic nerve
palsy after DCPBhemidiaphragmatic paresis and
heavy sensation
Oxygen, reassurance
Bilateral ??
Complications
Complications
• Total reversible blindness has also been
described after similar inadvertent injections
of small amounts (1 mL) of local anesthetic
into a vertebral artery.
• Carotid sheath compression by injecting the
local anesthetic anterior to the transverse
processes has been demonstrated by Labat to
possibly impair blood flow to the brain
• Carotid artery Stenosis ??
Complications
• Hematoma can compress pharynx and larynx
• Hoarseness secondary to vagal nerve block or
recurrent laryngeal nerve involvement
probably occurs more often than previously
thought. SCPB -2-3%. May be 60 % with DCPB
• Horner's syndrome- middle cervical ganglion
affected in DCPB
• Dysphagia may occur with pharyngeal plexus
block
Can decrease complications by
Caudad only
Summary
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Anatomy
Types
SCPB technique
DCPB – technique
Complications
• Overall , simple
• safe technique
• Thank you all