ABSTRACT
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.
Subject(s)
Humans , Adult , Cervical Plexus/anatomy & histology , Classification , Neck Muscles/innervation , Cadaver , Anatomic Landmarks , FetusABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Pain, Postoperative/prevention & control , Thyroidectomy , Cervical Plexus Block/methods , Analgesia/methods , Anesthesia, General , Treatment Outcome , Middle AgedABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Background: Bilateral Superficial cervical plexus block (BSCPB) is one method of post op analgesia given before General anesthesia as this avoids polypharmacy. Objectives: This prospective randomized, controlled clinical study compared the post-operative analgesic efficacy of BSCPB using Ropivacaine (0.5%) with or without Clonidine (2mcg/kg).It also evaluated the intra operative opioid dosage and hemodynamic responses in patients undergoing thyroid surgeries. Methods: 60 Patients undergoing thyroidectomy were randomized into 3 groups,(Group A) BSCPB using normal saline ,(group B)Ropivacaine (0.5%) , (group C) Ropivacaine (0.5%) with Clonidine (2mcg/kg) before GA. Intra and post-operative hemodynamic responses, fentanyl dosage and the time of rescue analgesia were assessed. Post op pain scores using VAS, nausea, vomiting and sedation were assessed for 24 hours.Results: The mean duration of analgesia is highly significant (p<0.001) in group C. Intra operative fentanyl requirement was significantly lesser in groups B and C (P<0.001). Intra operative hemodynamic changes were significant in Group B and C. Post operative pain scores were significantly lower in groups B and C for the first 24 hours (P<0.001).The time of rescue analgesia in group A was early when compared to group B and C (P<0.001) and in group B when compared to group C .Post operative nausea, vomiting were lower in group B and C. Conclusion: BSCPB performed prior to GA using 0.5% Ropivacaine with or without clonidine was effective in reducing intra and post-operative analgesic requirements. The addition of Clonidine 2mcg/kg had highest analgesic efficacy when compared to Ropivacaine alone.
ABSTRACT
A 70-year-old woman with an infectious thrombus in her left internal jugular vein (IJV) underwent carotid endarterectomy for stenosis and a highly movable plaque in her right carotid artery. She had been treated with antibiotics for four weeks before surgery due to Lemierre syndrome, a rare septic thrombophlebitis in the IJV secondary to an oropharyngeal infection. The right IJV was in a two-fold dilated state due to compensation for a thrombotic left IJV. Accordingly, superficial cervical plexus block was performed under ultrasound guidance to ensure safety and accuracy. During surgery, the alertness was maintained and the patient did not complain of pain in the absence of additional analgesics. No block-related complications were encountered. The authors report for the first time their regional anesthetic experiences in a patient with Lemierre syndrome.
Subject(s)
Aged , Female , Humans , Analgesics , Anti-Bacterial Agents , Carotid Arteries , Cervical Plexus Block , Cervical Plexus , Compensation and Redress , Constriction, Pathologic , Endarterectomy, Carotid , Jugular Veins , Lemierre Syndrome , Thrombophlebitis , Thrombosis , UltrasonographyABSTRACT
Herpes zoster most commonly occurs in elderly patients, and usually affects sensory neurons. Therefore, its characteristic symptoms are segmental pain, itching, and sensory changes in the affected areas. A 71-yr-old woman experienced painful herpetic rash on the right cervical 2-4 dermatomes for 16 days. Two days after the onset of the rash, she was diagnosed with herpes zoster, and prescribed 250 mg famciclovir three times a day for 7 days, pregabalin 150 mg twice a day, and tramadol 150 mg once a day for 14 days, by a dermatologist. Despite medication, her pain was rated at an intensity of 6/10 on the numeric rating scale. In addition, she complained of severe itching sensation on the affected dermatomes. Superficial cervical plexus block (SCPB) was performed at the right C4 level with 15 ml 0.5% lidocaine plus triamcinolone 30 mg. Five days after the procedure, pain and itching completely disappeared. SCPB may be an effective option for the treatment of acute pain and itching arising from herpes zoster, and for the prevention of postherpetic neuralgia.
Subject(s)
Aged , Female , Humans , Acute Pain , Cervical Plexus Block , Cervical Plexus , Exanthema , Herpes Zoster , Lidocaine , Neuralgia, Postherpetic , Pregabalin , Pruritus , Sensation , Sensory Receptor Cells , Tramadol , TriamcinoloneABSTRACT
The differential diagnosis of headache is often difficult because the symptom of headache is overlapping. Superficial cervical plexus block is useful in diagnosis and treatment of headache. Headache arising from the neck and radiating to the frontotemporal regions and possibly to the supraorbital region has been defined as cervicogenic headache. A positive response to anesthetic blocks is one of the diagnostic criteria of cervicogenic headache. We experienced a case of headache arising from direct lymph node metastasis of hepatocellular carcinoma adjacent to the superficial cervical plexus during treatment of cervicogenic headache under ultrasonographic guidance. Especially in patients with medical history of cancer, practitioners should consider the possibility of metastasis to cervical lymph nodes and using ultrasonography to evaluate the cervical area prior to the practice.