Chapter 23

Cervical plexus anesthesia was developed early in the twentieth century, and two main approaches were available to the early practitioners of regional anesthesia. In 1912, Kappis described a posterior approach to the brachial plexus while attempting to block spinal nerves at the point of emergence from the vertebral column.1 The main reason for a posterior approach to blocking the cervical plexus is the relative position of the vertebral artery and vein anterior to the plexus.2 However, the posterior approach is associated with discomfort during and after the blockade, most likely due to the puncture of the extensor muscles of the neck, and has been avoided by many practitioners. As a result, the posterior approach to the cervical plexus block has not been as popular as the lateral approach, although it has been utilized to block the brachial plexus either as a single-shot or continuous technique.2–5

In 1914, Heidenhein described the lateral approach, which has formed the basis for subsequent techniques of anesthetizing the cervical plexus.6 Victor Pauchet described a lateral approach to blocking the cervical plexus in 1920 and mentioned the posterior approach; however, he advocated the use of the lateral approach.7 Winnie revisited the lateral approach to the cervical plexus block in 1975, and it is currently the more used approach for the cervical plexus block.8

Deep and superficial cervical plexus block can be used to provide anesthesia for a variety of surgical procedures, including superficial operations on the neck and shoulders, thyroid operations, and carotid endarterectomies in which awake neurologic monitoring is a simple and reliable method of neurologic assessment (Figure 23–1).9,10 Eastcott described the first carotid endarterectomy in 1954, and the number of these surgeries performed in the United States grows each year.11 Regional anesthesia is a viable anesthetic choice for carotid surgery, although debate continues about whether regional or general anesthesia is the better choice for carotid endarterectomy surgery. Most of the latest literature points to regional anesthesia as a better choice.12–21 The outcome data from vascular surgery and neurosurgery literature shows that patients who undergo carotid endarterectomy under regional anesthesia may have better outcomes.22–25

###### Fig. 23-1

Carotid endarterectomy. The image shows open, cross-clamped carotid artery and a plaque inside its wall.

The superficial cervical plexus block can be used for many superficial surgeries in the neck area, including lymph node dissection, excision of thyroglossal or branchial cleft cysts, carotid endarterectomy, and vascular access surgery.26 If the superficial cervical plexus block is to be used alone for carotid endarterectomy, local anesthetic supplementation by the surgeon may be necessary.27,28 Although both the deep and superficial cervical plexus blocks can be performed separately, they are most often performed in combination to provide anesthesia and postoperative analgesia for head and neck surgery.29–31...

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