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Chapter 31A. Ultrasound-Guided Cervical Plexus Block

In which location is local anesthetic injected for a superficial (intermediate) cervical plexus block?

A. Superficially to the deep cervical fascia and not deep to the prevertebral fascia

B. Superficially to the deep cervical fascia and not between the investing layer of the deep cervical fascia and the prevertebral fascia

C. Between the investing layer of the deep cervical fascia and the prevertebral fascia, and not deep to the prevertebral fascia

D. Medial to the sternocleidomastoid muscle (SCM) and deep to the prevertebral fascia

C is correct. For the superficial (intermediate) cervical plexus block, the injection is made between the investing layer of the deep cervical fascia and the prevertebral fascia, whereas for the deep cervical plexus block, local anesthetic is deposited deep to the prevertebral fascia.

The best possible target location for depositing local anesthetic during superficial cervical plexus technique is:

A. Medial to the carotid artery

B. Lateral to the brachial plexus

C. In the vicinity of the cutaneous sensory branches of C2–C4.

D. Superficial to the carotid artery and internal jugular vein within the sternocleidomastoid muscle (SCM)

C is correct. The goal of the ultrasound (US)-guided technique of superficial cervical plexus block is to deposit local anesthetic within the vicinity of the sensory branches of the nerve roots C2, C3, and C4.

A is incorrect. This will be medial to the carotid artery and closer to the trachea and possible part of the thyroid gland.

B is incorrect. This will be too far from the location of the cervical plexus in relation to the brachial plexus.

D is incorrect. The plexus can be visualized as a small collection of hypoechoic nodules (honeycomb appearance or hypoechoic [dark] oval structures) immediately deep or lateral to the posterior border of the SCM and not within it.

Figure 31A–1 shows the anatomy of the deep cervical plexus and its main branches and anastomoses. Identify the supraclavicularis nerve.

A. A

B. B

C. C

D. D

Figure 31A–1

Anatomy of the deep cervical plexus and its main branches and anastomoses.

D is correct. This ...

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