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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
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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
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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
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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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