Tips & algorithm

 

  • The “deep” cervical plexus block is basically a cervical paravertebral block, an advanced technique with a risk of potentially severe complications.
  • The superficial cervical plexus block technique is simpler, safer, and, for most indications adequate.
  • In-plane or out-of-plane? The superficial location of the cervical plexus branches makes both approaches possible.
  • Do I need to visualize plexus? Not necessarily; injection of 10 mL of local anesthetic posterior and deep to the sternocleidomastoid muscle provides a reliable block.
  • Carotid surgery also requires blockade of the glossopharyngeal nerve branches, which is easily accomplished intraoperatively by injecting the local anesthetic inside the carotid artery sheath.