Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique / Transferência nervosa da raiz de C4 para C5 em lesões do plexo braquial. Estudo anatômico e descrição de técnica cirúrgica

Abstract Objective This is an anatomical study of C4 and C5 roots for nerve transfers in upper brachial plexus injuries, with surgical technique demonstration. Methods Fifteen brachial plexuses from both male and female cadavers were dissected. Morphological features of C4 and C5 roots were recorded and analyzed, followed by a neurotization simulation. Results In all dissections, C4 and C5 roots morphological features allowed their mobilization and neurotization with no need for a nerve graft. The surgical technique spared important regional nerve branches. Conclusion Based on these data, we conclude that C4-C5 nerve transfers are feasible and result in no additional neurological deficit in upper brachial plexus injuries.

Resumo Objetivo Estudo anatômico das raízes usadas na transferência nervosa de C4 para C5 nas lesões altas do plexo braquial, com demonstração da técnica cirúrgica. Métodos Dissecção de 15 plexos braquiais de cadáveres de ambos os sexos, registro e análise das características morfológicas das raízes de C4 e C5 e simulação de neurotização. Resultados As características morfológicas encontradas nas raízes de C4 e C5 em todas as dissecções permitiram a mobilização das mesmas e a realização de uma neurotização sem a necessidade de usar enxerto nervoso. A técnica cirúrgica permitiu preservar ramos nervosos importantes na região abordada. Conclusão Com base nos dados encontrados no presente estudo, podemos concluir que é possível realizar a transferência entre C4 e C5 sem provocar déficit neurológico adicional nas lesões altas de plexo braquial.

Effects of cervical plexus block anesthesia combined with general anesthesia on subtotal thyroidectomy in patients with hyperthyroidism and stress response / 中华地方病学杂志

Objective:To investigate the effects of cervical plexus block anesthesia combined with general anesthesia on subtotal thyroidectomy in patients with hyperthyroidism and stress response.Methods:A total of 68 patients with hyperthyroidism who underwent subtotal thyroidectomy in Zhangjiagang City Hospital of Traditional Chinese Medicine, Jiangsu Province, from January 2018 to January 2021 were selected as observation subjects, and were divided into control group and observation group according to the random number table method, both of which were 34 cases. Patients in control group were given general anesthesia, and the observation group was given cervical plexus block anesthesia combined with general anesthesia. The heart rate and mean arterial pressure before anesthesia (T0), immediately before intubation (T1), immediately after intubation (T2), and at the end of surgery (T3), the time of awakening and extubation after surgery, the visual analog score (VAS) of pain at 1, 4, 12, and 24 hours after surgery, stress response of before and 24 hours after surgery, and complications after surgery were compared between the two groups.Results:There was no significant difference in heart rate and mean arterial pressure between the two groups at T0 ( P > 0.05); the heart rate and mean arterial pressure at T1 were lower than those at T0 in the same group ( P < 0.05); the heart rate and mean arterial pressure at T2 and T3 in the control group were higher than those at T0 in the same group ( P < 0.05); the heart rate and mean arterial pressure at T2 and T3 in the observation group did not change significantly compared with those at T0 in the same group ( P > 0.05), but were lower than those in the control group at the same time ( P < 0.05). The awakening time and extubation time of patients in the observation group were shorter than those in the control group ( P < 0.001). The VAS scores of patients in the observation group were lower than those in the control group at 4, 12 and 24 hours after surgery ( P < 0.001). The serum norepinephrine (NE) and cortisol (COR) levels of patients in the two groups at 24 hours after surgery were higher than those before surgery, and the levels in the observation group were lower than those in the control group at the same time ( P < 0.05). The total incidence of postoperative complications in the observation group (8.82%, 3/34) was lower than that in the control group (29.41%, 10/34, χ 2 = 4.66, P = 0.031). Conclusion:Cervical plexus block anesthesia combined with general anesthesia has a good effect on subtotal thyroidectomy in patients with hyperthyroidism, which can speed up the patients' awakening, reduce complication, and has little impact on stress response.

Inervación suplementaria de la mandíbula y sus Implicancias clínicas: revisión narrativa / Supplemental innervation of the mandible and it´s clinical implications: narrative review

RESUMEN: En condiciones normales, la mandíbula y sus estructuras anatómicas (dientes, musculatura, piel), son inervadas por los ramos de la tercera división del nervio trigémino (nervio mandibular), sin embargo, existen reportes que evidencian inervación suplementaria de los dientes inferiores y la zona del ángulo mandibular. Lo último podría ser responsable del fracaso del bloqueo nervioso con anestesia local. El objetivo principal de esta investigación fue revisar artículos que describen la participación de otros nervios como el milohioideo y los ramos superficiales del plexo cervical, los cuales pueden ingresar a la mandíbula a través de forámenes ubicados a lo largo de su arquitectura. Para esto, se realizó una revisión narrativa de la literatura científica, en inglés y español, desde el año 1971 hasta el año 2019, utilizando las plataformas digitales PubMed, EBSCO, Cochrane library, Scielo y Google Scholar, literatura gris y además de una búsqueda manual. Acorde a los resultados de la revisión, se confirma la existencia de fracasos de técnicas anestésicas mandibulares debido a la inervación accesoria de la mandíbula y de los dientes inferiores, donde los tres principales nervios revisados tienen incidencia en este postulado. Finalmente se plantea un orden de ejecución para realizar la infiltración de anestésico local en la mandíbula para lograr un bloqueo exitoso durante los procedimientos odontológicos que la requieran.

SUMMARY: Under normal conditions, the mandible and its anatomical structures (teeth, muscles, skin) are innervated by the branches of the third division of the trigeminal nerve (mandibular nerve), however, there are reports that show supplementary innervation of the lower teeth and the mandibular angle area. The latter could be responsible for the failure of the nerve block under local anesthesia. The main objective of this research; is to review articles that describe the participation of other nerves such as the mylohyoid nerve, and the superficial branches of the cervical plexus, which can enter the mandible through foramina located along its architecture. For this, a narrative review of the scientific literature was carried out, in English and Spanish, from 1971 to 2019, using the digital platforms PubMed, EBSCO, Cochrane library, Scielo and Google Scholar, gray literature and in addition to a search Handbook. According to the results of the review, the existence of the failures of the mandibular anesthetic techniques due to the accessory innervation of the mandible and the lower teeth is confirmed, where the three main nerves reviewed have an impact on this postulate. In conclusion, an order of execution is proposed to perform local anesthetic infiltration into the jaw to achieve a successful block during dental procedures that require it.

Classification of the patterns of the emerging branches of the superficial cervical plexus / Clasificación de los patrones de las ramas emergentes del plexo cervical superficial

SUMMARY: The cutaneous branches of the superficial cervical plexus (SCP) emerge at variable points, from beneath the posterior margin of the sternocleidomastoid muscle and from this point radiate like "spokes of a wheel" antero-inferiorly and postero-superiorly. This study aimed to classify the emerging points of the branches of the superficial cervical plexus in relation to their location on the sternocleidomastoid muscle. In order to classify the emerging points of the superficial cervical plexus, the sternocleidomastoid muscle was first measured from mastoid process to clavicle; subsequently each branch of the superficial cervical plexus was measured from the mastoid process to their exit points. The emerging points of the superficial cervical plexus branches were classified according to Kim et al. (2002) seven categories: Type I (32 %); Type II (13 %); Type III (35 %); Type IV (13 %); Type V, VI, VII (2 %). The order in which the superficial cervical plexus branches emerged from the posterior margin of the sternocleidomastoid muscle remained constant, i.e. lesser occipital, great auricular, transverse cervical and supraclavicular nerves. Knowledge of emerging points may assist in the effective anaesthesia to all branches of the superficial cervical plexus during surgical procedures of the neck, viz. carotid endarterectomy and thyroid surgery.

RESUMEN: Las ramas cutáneas del plexo cervical superficial (SCP) emergen en puntos variables, desde el margen pos- terior del músculo esternocleidomastoideo y desde este punto inferior irradian como "radios de rueda" anteroinferior y postero-superior. Este estudio tuvo como objetivo clasificar los puntos emergentes de las ramas del plexo cervical superficial en relación a su ubicación en el músculo esternocleidomastoideo. Para clasificar los puntos emergentes del plexo cervical superficial, primero se midió el músculo esternocleidomastoideo desde el proceso mastoides hasta la clavícula; posteriormente se midió cada rama del plexo cervical superficial desde el proceso mastoideo hasta sus puntos de salida. Los puntos emergentes de las ramas del plexo cervical superficial se clasificaron según Kim et al. (2002) en siete categorías: Tipo I (32 %); Tipo II (13 %); Tipo III (35 %); Tipo IV (13 %); Tipo V, VI, VII (2 %). El orden en el que las ramas del plexo cervical superficial emergían del margen posterior del músculo esternocleidomastoideo se mantuvo constante, es decir, los nervios occipital menor, auricular magno, cervical transverso y supraclavicular. El conocimiento de los puntos emergentes puede ayudar a la anestesia eficaz de todas las ramas del plexo cervical superficial durante los procedimientos quirúrgicos del cuello, a saber, endarterectomía carotídea y cirugía de tiroides.

Cervical plexus block as an alternative anesthetic approach for type I thyroplasty: a case report / Bloqueio do plexo cervical como técnica anestésica alternativa para tireoplastia tipo I: relato de caso

Abstract Background: The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. Case report: A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. Conclusion: The use of a regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.

Resumo Introdução: O papel da tireoplastia tipo I (TPI) está bem estabelecido no tratamento de insuficiência glótica após a paralisia das pregas vocais, mas o manejo anestésico ideal para a TPI ainda é controverso. Descrevemos uma nova técnica anestésica para a TPI usando o Bloqueio do Plexo Cervical (BPC) superficial e o BPC intermediário associados, em presença de analgo-sedação leve e intermitente. Relato de caso: Paciente de 51 anos de idade com paralisia da prega vocal esquerda e apneia obstrutiva do sono foi agendada para TPI. BPC intermediário guiado por ultrassom foi realizado usando acesso posterior, e 15 mL de ropivacaína a 0,5% foram injetados no espaço cervical posterior entre o músculo esternocleidomastoideo e a fáscia prevertebral. A seguir, para o BPC superficial, 10 mL de ropivacaína a 0,5% foram injetados na região subcutânea adjacente à borda posterior do músculo esternocleidomastoideo, sem transfixar a fáscia de revestimento. Analgo-sedação intermitente com infusão alvo-controlada de remifentanil (alvo de 0,5 ng.mL-1) foi usada para facilitar a inserção da prótese e a laringoscopia com fibra ótica. A técnica ofereceu via aérea segura durante a anestesia, boa condição para o cirurgião, possibilidade de monitorar a voz, além de ótimo conforto à paciente. Conclusões: O uso de anestesia regional é uma técnica promissora para o cuidado anestésico durante a TPI, especialmente em pacientes com via aérea comprometida.

Anatomical variations of sensory nerve branches of the cervical plexus

Introduction: The cervical plexus is formed by the union of the anterior branches of the cervical nerves from C1to C4. These nerves originates sensory fibers and motor that will innervate the skin, muscles, glands and regionsof the head and neck.Objective: In literature, it has been a frequent description of findings of anatomical variations of peripheralnerves of the cervical plexus. A study of descriptive type anatomical design was carried out by observing theformation of the cervical plexus of its peripheral nerve branches, and search of possible anatomic variations ofthese nerve branches.Methods: This study was conducted with Bilateral dissections were performed in 32 stillborns, formalin- fixed,all males with a mean age of 26.5 weeks (SD = 2.121). The fetuses were meticulously dissected and the formationof cervical plexus and its branches were observed. Results and Discussion: Among the 32 fetuses dissected, itfound a variation of the CTN and an anastomosis between CTN and SCN and an anatomical variation was foundin the form of anastomosis between the roots C1 to C4, forming a common trunk from which emerge some othernerve branches.Conclusion: The most frequent anatomical identifications were confirmed, some variations already describedand verification of new variations of the sensory branches in the cervical plexus. The identification of thesensory branches of the cervical plexus, and anatomical variants may help in clinical, therapeutic, surgical anddiagnostics

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial / Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado

Abstract Introduction: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methods: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. Results: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p= 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p< 0.01), 30 (p< 0.01) minutes, and 1 (p< 0.01), 2 (p< 0.01), 6 (p< 0.01), 12 (p< 0.01) and 24 (p= 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p= 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p= 0.004). Conclusion: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Resumo Introdução: O bloqueio bilateral do plexo cervical superficial (BPCS) é um método comumente usado para analgesia em tireoidectomia. Avaliamos a eficácia analgésica do bloqueio bilateral do BPCS nos períodos intraoperatório e pós-operatório. Materiais e métodos: Os pacientes (n = 46) submetidos à tireoidectomia foram randomicamente separados em dois grupos para receber anestesia geral (Grupo GA; n = 23) e anestesia geral mais bloqueio bilateral do BPCS (Grupo GS; n = 23). Avaliamos a necessidade de analgésico no intraoperatório (remifentanil) e os escores VAS (Visual Analog Scale) em vários momentos no pós-operatório (após a extubação, aos 15 e 30 minutos e em 1, 2, 6, 12, 24 e 48 horas de pós-operatório). O consumo total de tramadol e paracetamol e a quantidade usada de ondansetrona foram registrados. Resultados: A necessidade de remifentanil no intraoperatório foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,009). Os escores de dor pós-operatória foram significativamente menores no Grupo GS do que no grupo GA aos 15 (p < 0,01) e 30 (p < 0,01) minutos e em 1 (p < 0,01), 2 (p < 0,01), 6 (p < 0,01), 12 (p < 0,01) e 24 (p = 0,03) horas de pós-operatório. A necessidade de tramadol no pós-operatório foi significativamente menor no Grupo GS do que no grupo GA (p = 0,01). O número de pacientes que recebeu ondansetrona foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,004). Conclusão: O bloqueio bilateral do BPCS com bupivacaína a 0,25% reduz a intensidade da dor pós-operatória e a dependência de opioides em pacientes submetidos à tireoidectomia.

A Randomized Double-Blind Placebo-Controlled Clinical Trial To Assess The Efficacy Of Dexamethasone To Provide Postoperative Analgesia After Cervical Plexus Block In Patients Undergoing Elective Thyroid Surgery

In an attempt to improve the patient comfort after thyroidectomy, various methods of pain-relief have been tried to prolong the duration and to improve the quality of postoperative analgesia. Cervical plexus block using steroids like dexamethasone, administered as an adjuvant along with local anaesthetic agents, could be of particular interest. Methods: Fifty patients undergoing elective thyroidectomy were randomly assigned to one of the following groups containing twenty five patients each. Group D patients received 8 mg (2 ml) of dexamethasone added to 13 ml of 0.25% levobupivacaine as cervical plexus block (total volume 15 ml). Group L patients received 13 ml of 0.25% levobupivacaine and 2 ml of isotonic saline (15 ml in total) as cervical plexus block. Analgesic effect was evaluated by measuring pain intensity (VAS score) and duration of analgesia. Results: A longer delay was observed for first requirement of supplementary analgesic in group D (572.24±68.42 minutes ) compared to group L (402.46±52.34 minutes). Total consumption of diclofenac sodium in first 24 hours in postoperative period was significantly less in group D. No significant side effects were noted. Conclusion: Dexamethasone, used as adjuvant to levobupivacaine for cervical plexus block in patients undergoing thyroidectomy, improve the quality and prolong the duration of post operative analgesia.

A Rare Case Of Bilateral Variant Ansa Cervicalis And Review Of Literature

Ansa cervicalis is a nerve loop that is embedded in the anterior wall of carotid sheath of the neck. It is formed bydescendent hypoglossi and descendens cervicalis. It supplies the infrahyoid muscles. During routine dissection,a rare variant in the morphology of Ansa cervicalis was observed in adult male cadaver. The variant ansacervicalis exhibited two loops, and was present bilaterally. The formation, course and relations of the nerve loopis complex. During literature search, we came across studies which propose different classifications. Hence wehave added a note on the different classifications.Ansa cervicalis is important since it can be used in nerve-nerve anastomosis, nerve-muscle pedicle implantationin relation to reconstructive surgeries of larynx. Hence, the knowledge of variations in the formation, anddistribution is relevant. It can affect the outcome during reinnervation surgeries following recurrent laryngealparalysis and surgeries around this area of neck.

Comparative Evaluation of Efficacy of Interscalene Block vs. Interscalene Block and Superficial Cervical Plexus Block for Fixation of Clavicular Fractures

Introduction: Regional anaesthesia is seldom used forclavicle fractures considering the anatomical location of thebone. We aim to compare the efficacy of two techniques ofregional anaesthesia as sole anaesthesia technique for fixationsof clavicular fractures.Material and methods: 60 Adult patients with claviclefractures were divided randomly in two groups (1 and 2) andwere administered interscalene block (ISB) only or interscaleneblock and superficial cervical plexus block(ISB+SCPB) assole anaesthetic, respectively. Patients were monitored forefficacy of block and adequacy of anaesthesia and analgesiaat the surgical site. Side effects and hemodynamic parameterswere also monitored.Results:. ISB+SCPB provides excellent anaesthesia forclavicle fixation. Only 1 patient in group 2 required GeneralAnaesthesia(GA) whereas in Group 1, 8 patients required someform of supplemental anaesthesia. There was no statisticallysignificant difference in side-effects and hemodynamic profilein both the groups.Conclusion: ISB+SCPB is significantly better than ISB onlyfor anaesthesia for fixation of clavicular surgeries.

A Comparison of Combined Superficial Cervical Plexus Block and Interscalene Brachial Plexus Block with General Anesthesia for Clavicle Surgery: Pilot Trial

OBJECTIVE: Recently, the cases about successful regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block for clavicle surgery have been reported. The aim of this study was to compare regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block with general anesthesia. METHODS: In this prospective randomized study, 26 patients scheduled for elective clavicle surgery were divided into two groups: the first group was general anesthesia group (GA group, n=13) and the second group for peripheral nerve block group (PNB group, n=13). Standardized general anesthesia was done to the patients assigned to the GA group and ultrasonography-guided combined superficial cervical plexus block and interscalene brachial plexus block was done to the patients assigned to the PNB group. Postoperative sedation scale was assessed at post-anesthesia care unit, and pain scale using 10-cm Visual Analog Scale (VAS) was assessed at immediate postoperative, 30 minutes, 1 hour, 6 hours, and 24 hours. Patients needed additional analgesics, and time for first analgesic demand and duration from surgery to discharge was recorded. RESULTS: The pain VAS scales were less in PNB group than GA group from immediate postoperative time to 6 hours. The patients' immediate postoperative sedation scale less than 4 were significantly less in PNS group than GA group. The duration from surgery to discharge was shorter in PNS group than GA group. CONCLUSION: Regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block is a successful alternative to general anesthesia for clavicle surgery.

Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial

OJECTIVES: The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS: In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS: The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS: The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.

Clinical study of electroacupuncture on perioperative analgesia in patients with thyroid surgery under cervical plexus block / 中国针灸

OBJECTIVE@#To investigate the change trend and correlation between the perioperative pain degree and neuroendocrine hormone levels in the perioperative period on patients with thyroid surgery by electroacupuncture combined with cervical plexus block.@*METHODS@#Forty patients with elective thyroidectomy were enrolled and divided into a control group and an observation group according to the random number table method, 20 cases in each group. In the control group, cervical plexus block was performed. In the observation group, the cervical plexus block combined with electroacupuncture (EA) were given. After the cervical plexus block was completed, the EA was applied at the bilateral Hegu (LI 4) and Neiguan (PC 6) for 30 min. The visual analog scale (VAS) was used to assess the pain level before anesthesia (T), 2 h after operation (T), 12 h after operation (T), 24 h after operation (T) and 48 h after operation (T). Blood samples such as adrenocorticotropic hormone (ACTH), C-reactive protein (CRP) and β-endorphin (β-EP) were collected to measure the level of neuroendocrine hormones, and to analyze the correlation between ACTH, CRP, β-EP and VAS scores.@*RESULTS@#The VAS scores at T, T, T were higher than those at T in the two groups (all <0.05). The VAS scores T, T and T in the observation group were lower than those in the control group (all <0.05). The ACTH and CRP in the control group at T, T and T were significantly higher than those at T (all <0.05). The β-EP in the observation group at T, T and T was significantly higher than that at T (all <0.05). The ACTH and CRP in the observation group at T, T and T were lower than those in the control group,and the β-EP level was higher than that in the control group (all <0.05).The VAS score was significantly positively correlated with ACTH and CRP levels, and negatively correlated with β-EP.@*CONCLUSION@#EA stimulation can inhibit the secretion of ACTH and CRP, promote the release of β-EP, reduce the perioperative pain score, and inhibit the body's stress response.

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study / 영남의대학술지

BACKGROUND: Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.METHODS: Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.RESULTS: There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p < 0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p < 0.0001 between 0–6 h, p < 0.004 between 6–12 h, and p < 0.001 between 12–24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p < 0.001).CONCLUSION: In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Cervical plexus block / 대한마취과학회지

Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.

Ultrasound-guided application of cervical plexus nerve block in radiofrequency ablation of thyroid and parathyroid benign lesions / 中华超声影像学杂志

Objective To investigate the efficacy of ultrasound-guided cervical plexus block in radiofrequency ablation of thyroid and parathyroid benign lesions . Methods One hundred and twenty-five patients with thyroid nodules or hyperparathyroidism , who were undergone ultrasound guided radiofrequency ablation ,were randomly assigned to receive either ultrasound-guided cervical plexus block or local infiltration anesthesia ,and the pain grading was evaluated by numerical rating scale ( NRS ) . The anesthetic dosage and the effect of thermal ablation surgery of ultrasound-guided cervical plexus block anesthesia and local anesthesia were compared . Results The anesthetic dosage in ultrasound-guided cervical plexus block was lower than that in local infiltration anesthesia( t = 17 .681 , P < 0 .05) . The pain grading of ultrasound-guided cervical plexus block was lower than that of local infiltration anesthesia( χ2 = 33 .738 , P < 0 .05) . Conclusions Ultrasound-guided cervical plexus nerve block has lower anesthetic dosage and pain grading in the radiofrequency ablation of thyroid and parathyroid benign lesions ,which may be widely applied in clinical .

Application of ultrasound guided brachial plexus combined with deep cervical plexus nerve block in shoulder arthroscopic surgery / 天津医药

@#Objective To evaluate the effect of ultrasound guided brachial plexus combined with deep cervical plexus nerve block in shoulder arthroscopic surgery. Methods A total of 60 cases under shoulder arthroscopic surgery were randomly divided into two groups: general anesthesia group (GA) and nerve block group (NA), with 30 cases in each group. Patients of group GA were given general anesthesia, and patients of group NA were given ultrasound guided brachial plexus block with deep cervical plexus nerve block. Data of the haemodynamics of patients, the time for the first feeding of water after operation, ambulation postoperation, the total cost of anesthesia, the average hospitalization days, the satisfaction of anesthesia in patients and surgeons, the pain scores (VAS) at 2, 4, 8, 12 h postoperation, the proportion of patients that needed additional analgesic drugs and the adverse events in 12 h postoperation were all recorded. Results There were no significant differences in gender, age, body mass index (BMI), operation time, intraoperative systolic pressure, diastolic pressure and mean arterial pressure, the minimum heart rate, the satisfaction of anesthesia in patients and surgeons, the proportion of postoperative 12 h VAS score ≤ 3 and the need for additional analgesic drugs between two groups of patients (P＞0.05). In group NA, the intraoperative systolic pressure, diastolic pressure and mean arterial pressure and the maximum heart rate were lower than those in group GA. The time of the first feeding water, and ambulation post operation were shorter in group NA than those of group GA. The incidence of adverse reactions was significantly lower in group NA than that in group GA. The total anesthesia cost and the average hospitalization days were significantly lower in group NA than those of group GA. The proportion of postoperative VAS score ≤ 3 at 2, 4 and 8 h was higher in group NA than that of group GA. The proportion of patients needed additional analgesic drugs was significantly lower in group NA than that of GA group (P < 0.05). Conclusion Ultrasound-guided brachial plexus combined with deep cervical plexus nerve block is a reliable choice for shoulder arthroscopic surgery, which can promote the rapid rehabilitation of patients.

A randomized placebo-controlled trial to assess the efficacy and safety of bilateral superficial cervical plexus block in patients undergoing thyroid surgery

Background: Efficient analgesia and achieving hemodynamic stability is vital in patients undergoing thyroid surgery. Bilateral superficial cervical plexus block (BSCPB) is one of the commonly performed regional anaesthesia technique, but studies documenting the superiority of various local anaesthetic medication, as compared to placebo are scarce. To compare the efficacy of analgesia, intra and post-operative hemodynamic status between bilateral superficial cervical plexus block with 0.5% bupivacaine and a control group (normal saline) in thyroid surgeries. Materials and methods: The current study was a randomized double-blinded controlled trial conducted with prior ethical approval. The study population included, people undergoing thyroid surgery under general anaesthesia, randomized to either 0.5% Bupivacaine or normal saline groups. The post-operative pain was assessed by Visual Analogue Scale (VAS). The intra and postoperative hemodynamic parameters were compared. Unpaired t-test, Mann-Whitney U test was used appropriately. Results: A total of 58 patients included in the final analysis, with 29 subjects in each group. Both the study groups were comparable, with respect to various baseline parameters. The highest difference in the mean visual analogue score was observed in the immediate post-operative period (mean difference 4.03, 95 CI 3.4 to 4.66, p value < 0.001). This difference even though was variable and lower compared to the immediate post-operative value, was sustained throughout the post-operative R. Vasanthageethan, G. Sivakumar, R. Arunachalam. A randomized placebo-controlled trial to assess the efficacy and safety of bilateral superficial cervical plexus block in patients undergoing thyroid surgery. IAIM, 2018; 5(8): 64-71. Page 65 period. At 24 hours, post-operative period the mean difference in visual analogue score was 1.55 (95% CI 0.93 to 2.16, p value < 0.001). All these differences in the mean visual analogue scores were statistically significant at p value < 0.05. No major hemodynamic fluctuations were observed in either of the study groups and no statistically significant difference was observed with respect to various hemodynamic parameters. Conclusions: The data and statistical analysis suggest that Bilateral Superficial Cervical Plexus Block with bupivacaine did not alter the intraoperative hemodynamic parameters and was effective in reducing the pain during the postoperative period. No significant adverse effects were noted both during surgery and postoperative period.

Effects of bilateral superficial cervical plexus block on sevoflurane consumption during thyroid surgery under entropy-guided general anesthesia: a prospective randomized study / 대한마취과학회지

BACKGROUND: Bilateral superficial cervical plexus block (BSCPB) provides good postoperative analgesia, but its effect on anesthetic consumption is unknown. This study evaluated the effects of BSCPB on sevoflurane consumption during thyroid surgery. METHODS: Fifty patients were randomly allocated into groups A and B of 25 each in this prospective double-blind study. Group A received BSCPB with 20 ml 0.25% bupivacaine, whereas group B received 20 ml saline immediately before entropy-guided general anesthesia. Intraoperative hemodynamic parameters, end-tidal sevoflurane concentration, minimum alveolar concentration, and sevoflurane consumption were recorded. Postoperative pain was assessed using a visual analog scale, and the time of the first request for analgesia was noted. All side effects were recorded. RESULTS: Demographics were comparable. Mean sevoflurane consumption [for 30 min: group A = 7.2 (1.1) ml, group B = 8.8 (2.0) ml, P = 0.001; for 60 min: group A = 13.5 (1.7) ml, group B = 16.5 (3.9) ml, P = 0.002] and mean end-tidal sevoflurane concentration [for 30 min: group A = 1.2% (0.2%), group B = 1.4% (0.2%), P = 0.008; for 60 min: group A = 1.2% (0.1%), group B = 1.4% (0.2%), P = 0.010] were significantly lower in group A. Patients in group A had a longer duration of analgesia [361.6 (79.5) min vs. 151.0 (60.2) min, P < 0.001] compared to those in group B. CONCLUSIONS: Preinduction BSCPB during thyroid surgery significantly reduced sevoflurane consumption and increased the duration of postoperative analgesia.

High-resolution Imaging of Neural Anatomy and Pathology of the Neck

The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.