Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May;58(3):327-9.
doi: 10.4103/0019-5049.135050.

Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle

Harsha Shanthanna  1
Affiliations

Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle

Harsha Shanthanna. Indian J Anaesth. 2014 May.

Abstract

We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block.

Keywords: Nerve block; regional analgesia; ultrasound.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
(a) Identification of C7 level: Prominent posterior tubercle with almost no anterior tubercle. (b) Identification of C6 level: Prominent anterior tubercle (Chassaignac tubercle)
Figure 2
Figure 2
(a) Identification of C5 nerve root with important vascular structures visualised in the medial aspect. (b) C5 nerve root between the “camel humps” formed by anterior and posterior tubercles - with the needle approaching from posterior
See this image and copyright information in PMC

References

    1. Nadeau MJ, Lévesque S, Dion N. Ultrasound-guided regional anesthesia for upper limb surgery. Can J Anaesth. 2013;60:304–20. - PubMed
    1. Kline JP. Ultrasound-guided placement of combined superficial cervical plexus and selective C5 nerve root catheters: A novel approach to treating distal clavicle surgical pain. AANA J. 2013;81:19–22. - PubMed
    1. Narouze SN, Vydyanathan A, Kapural L, Sessler DI, Mekhail N. Ultrasound-guided cervical selective nerve root block: A fluoroscopy-controlled feasibility study. Reg Anesth Pain Med. 2009;34:343–8. - PubMed
    1. Choi DS, Atchabahian A, Brown AR. Cervical plexus block provides postoperative analgesia after clavicle surgery. Anesth Analg. 2005;100:1542–3. - PubMed
    1. Herring AA, Stone MB, Frenkel O, Chipman A, Nagdev AD. The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med. 2012;30:1263–7. - PubMed