Superficial cervical plexus—skin and superficial structures (see Figures 130-1 and 130-2).
Figure 130-1. Anatomy of the Superficial Cervical Plexus
The superficial cervical plexus arises from C1 to C4 and runs between the cervical vertebrae and the sternocleidomastoid muscle. Nerves exit along the posterior border of the sternocleidomastoid coming through the platysma muscle. It provides sensation to the neck, jaw, occiput, and the anterior supraclavicular area. Reproduced from Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. Figure 17-2. Available at: www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.
Figure 130-2. Dermatomal Distribution of the Superficial Cervical Plexus
Reproduced from Hadzic A. The New York School of Regional Anesthesia Textbook of Regional Anesthesia and Acute Pain Management. Figure 3-12. Available at: www.accessanesthesiology.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.
Deep cervical plexus—muscles of the neck, deep structures, and diaphragm (phrenic).
Superficial (Figure 130-3):
- Identify the posterior border of the sternocleidomastoid (SCM) muscle
- Find the midpoint of the muscle and inject 5 mL of local anesthesia no deeper than the depth of the SCM
- Infiltrate superficially along the posterior border of the SCM to complete the block
- Ultrasound-guided technique: the injection is made at the level of C6, in the plane under the prevertebral fascia underlying the SCM. In some patients, the nerves of the cervical plexus can be identified in that space (see Fig. 133-4)
Figure 130-3. Superficial Cervical Plexus Block
Reproduced with permission from Miller RD, ed. Miller's Anesthesia. 6th ed. New York: Churchill Livingstone; 2005:1706. © Elsevier.
- Identify the mastoid process and the transverse process of C6. Draw a line connecting the mastoid process and C6 along the posterior border of the SCM muscle
- Identify the transverse processes of C2, C3, and C4 on this line; C2 will be the first palpable transverse process inferior to the mastoid process; alternatively, if the transverse processes cannot be palpated, draw the following landmarks:
- C2 is 1.5 cm posterior to the mastoid–C6 line, and 1.5 cm caudad to the mastoid
- C3 is 1.5 cm caudad to C2, and 1 cm from the line
- C4 is 1.5 cm caudad to C3, on the line
- Insert the needle and make contact with the transverse process of C3; withdraw the needle 1–2 mm and inject 5 mL of local anesthesia, and then repeat at C2 and C4
- Conversely, one can also inject 15 mL of local ...