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. 2013;42(2):29945724.
doi: 10.1259/dmfr/29945724. Epub 2012 Aug 29.

Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery

C Perisanidis  1 , T Saranteas, G Kostopanagiotou
Affiliations

Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery

C Perisanidis et al. Dentomaxillofac Radiol. 2013.

Abstract

Objectives: We examined the application of an ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in patients undergoing oral and maxillofacial surgery.

Methods: A total of 19 patients receiving ultrasound-guided combined intermediate and deep cervical plexus anaesthesia followed by neck surgery were examined prospectively. The sternocleidomastoid and the levator of the scapula muscles as well as the cervical transverse processes were used as easily depicted ultrasound landmarks for the injection of local anaesthetics. Under ultrasound guidance, a needle was advanced in the fascial band between the sternocleidomastoid and the levator of the scapula muscles and 15 ml of ropivacaine 0.75% was injected. Afterwards, the needle was advanced between the levator of the scapula and the hyperechoic contour of the cervical transverse processes and a further 15 ml of ropivacaine 0.75% was injected. The sensory block of the cervical nerve plexus, the analgesic efficacy of the block within 24 h after injection and potential block-related complications were assessed.

Results: All patients showed a complete cervical plexus nerve block. No patient required analgesics within the first 24 h after anaesthesia. Two cases of blood aspiration were recorded. No further cervical plexus block-related complications were observed.

Conclusions: Ultrasound-guided combined intermediate and deep cervical plexus block is a feasible, effective and safe method for oral and maxillofacial surgical procedures.

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Figures

Figure 1
Figure 1
The levator of the scapula muscle as it runs below the sternocleidomastoid muscle and the fascial band formed by the fusion of the investing and pre-vertebral fascia are clearly visualized with two-dimensional ultrasound imaging. F, fascial band between the levator of the scapula and sternocleidomastoid muscles; LS, levator of the scapula; SCM, sternocleidomastoid muscle
Figure 2
Figure 2
The third cervical transverse process is depicted in the cervical paravertebral space. F, fascial band between the levator of the scapula and sternocleidomastoid muscles; LS, levator of the scapula; SCM, sternocleidomastoid muscle; TP, C3 cervical transverse process
Figure 3
Figure 3
Colour Doppler is used for the identification of vertebral vessels. F, fascial band between the levator of the scapula and sternocleidomastoid muscles; LS, levator of the scapula; SCM, sternocleidomastoid muscle; VA, vertebral artery
Figure 4
Figure 4
(a) Local anaesthetic injection in the fascial band is clearly depicted. (b) Local anaesthetic injection in the cervical paravertebral space is clearly visualized. F, fascial band between the levator of the scapula and sternocleidomastoid muscles; LA, local anaesthetic; LS, levator of the scapula; SCM, sternocleidomastoid muscle; TP, C3 cervical transverse process
Figure 5
Figure 5
Time–motion analysis of diaphragm craniocaudal displacement during (a) normal and (b) deep inspiration
See this image and copyright information in PMC

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