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Intermediate Cervical Plexus Block
Rafael Vazquez, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Post Procedure

        • Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Cervical plexus block (CPB)
              • Intermediate cervical plexus block (ICPB)
              • Sternocleidomastoid (SCM)
              • Anterior scalene muscle (ASM)
              • Middle scalene muscle (MSM)
            • Synonyms

              • Superficial CPB
            • Definitions

              • Fascial plane block of superficial CPB, which results in somatic anesthesia to cervical region extending from periauricular areas and skin inferior to clavicle on chest wall
                • Sensory branches of C2, C3, and C4 travel between investing layer of deep cervical fascia and prevertebral fascia, know as posterior cervical space (PCS), typically at C4 level
                  • Branches include: Lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves
                  • ICPB refers to utilization of ultrasound to access this space
                    • Superficial CPB refers to subcutaneous injection of local anesthetic to target superficial branches of plexus
                • Duration of block is 4-6 hours

            PREPROCEDURE

            • Indications

              • Contraindications

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Thawale R et al: Ultrasound-guided intermediate cervical plexus block with depot steroids in the management of refractory neck pain secondary to cervicothoracic myofascial pain syndrome: a case series. A A Pract. ePub, 2019
                                      2. Kim JS et al: Cervical plexus block. Korean J Anesthesiol. 71(4):274-88, 2018
                                      3. Sait Kavaklı A et al: Comparison of combined (deep and superficial) and intermediate cervical plexus block by use of ultrasound guidance for carotid endarterectomy. J Cardiothorac Vasc Anesth. 30(2):317-22, 2016
                                      4. Calderon AL et al: Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study. Anaesthesia. 70(4):445-51, 2015
                                      5. Choquet O et al: Ultrasound-guided deep or intermediate cervical plexus block: the target should be the posterior cervical space. Anesth Analg. 111(6):1563-4; author reply 1564-5, 2010
                                      6. Tran DQ et al: A randomized comparison between ultrasound-guided and landmark-based superficial cervical plexus block. Reg Anesth Pain Med. 35(6):539-43, 2010
                                      7. Usui Y et al: An anatomical basis for blocking of the deep cervical plexus and cervical sympathetic tract using an ultrasound-guided technique. Anesth Analg. 110(3):964-8, 2010
                                      8. Narouze S: Sonoanatomy of the cervical spinal nerve roots: implications for brachial plexus block. Reg Anesth Pain Med. 34(6):616, 2009
                                      9. Guay J: Regional anesthesia for carotid surgery. Curr Opin Anaesthesiol. 21(5):638-44, 2008
                                      10. Nash L et al: Does the investing layer of the deep cervical fascia exist? Anesthesiology. 103(5):962-8, 2005
                                      11. Telford RJ et al: Correct nomenclature of superficial cervical plexus blocks. Br J Anaesth. 92(5):775; author reply 775-6, 2004
                                      12. Pandit JJ et al: Spread of injectate with superficial cervical plexus block in humans: an anatomical study. Br J Anaesth. 91(5):733-5, 2003
                                      13. Castresana MR et al: Incidence and clinical significance of hemidiaphragmatic paresis in patients undergoing carotid endarterectomy during cervical plexus block anesthesia. J Neurosurg Anesthesiol. 6(1):21-3, 1994
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Post Procedure

                                            • Procedure

                                              • Outcomes

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Cervical plexus block (CPB)
                                                  • Intermediate cervical plexus block (ICPB)
                                                  • Sternocleidomastoid (SCM)
                                                  • Anterior scalene muscle (ASM)
                                                  • Middle scalene muscle (MSM)
                                                • Synonyms

                                                  • Superficial CPB
                                                • Definitions

                                                  • Fascial plane block of superficial CPB, which results in somatic anesthesia to cervical region extending from periauricular areas and skin inferior to clavicle on chest wall
                                                    • Sensory branches of C2, C3, and C4 travel between investing layer of deep cervical fascia and prevertebral fascia, know as posterior cervical space (PCS), typically at C4 level
                                                      • Branches include: Lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves
                                                      • ICPB refers to utilization of ultrasound to access this space
                                                        • Superficial CPB refers to subcutaneous injection of local anesthetic to target superficial branches of plexus
                                                    • Duration of block is 4-6 hours

                                                PREPROCEDURE

                                                • Indications

                                                  • Contraindications

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things to Do

                                                                    • Things to Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Thawale R et al: Ultrasound-guided intermediate cervical plexus block with depot steroids in the management of refractory neck pain secondary to cervicothoracic myofascial pain syndrome: a case series. A A Pract. ePub, 2019
                                                                          2. Kim JS et al: Cervical plexus block. Korean J Anesthesiol. 71(4):274-88, 2018
                                                                          3. Sait Kavaklı A et al: Comparison of combined (deep and superficial) and intermediate cervical plexus block by use of ultrasound guidance for carotid endarterectomy. J Cardiothorac Vasc Anesth. 30(2):317-22, 2016
                                                                          4. Calderon AL et al: Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study. Anaesthesia. 70(4):445-51, 2015
                                                                          5. Choquet O et al: Ultrasound-guided deep or intermediate cervical plexus block: the target should be the posterior cervical space. Anesth Analg. 111(6):1563-4; author reply 1564-5, 2010
                                                                          6. Tran DQ et al: A randomized comparison between ultrasound-guided and landmark-based superficial cervical plexus block. Reg Anesth Pain Med. 35(6):539-43, 2010
                                                                          7. Usui Y et al: An anatomical basis for blocking of the deep cervical plexus and cervical sympathetic tract using an ultrasound-guided technique. Anesth Analg. 110(3):964-8, 2010
                                                                          8. Narouze S: Sonoanatomy of the cervical spinal nerve roots: implications for brachial plexus block. Reg Anesth Pain Med. 34(6):616, 2009
                                                                          9. Guay J: Regional anesthesia for carotid surgery. Curr Opin Anaesthesiol. 21(5):638-44, 2008
                                                                          10. Nash L et al: Does the investing layer of the deep cervical fascia exist? Anesthesiology. 103(5):962-8, 2005
                                                                          11. Telford RJ et al: Correct nomenclature of superficial cervical plexus blocks. Br J Anaesth. 92(5):775; author reply 775-6, 2004
                                                                          12. Pandit JJ et al: Spread of injectate with superficial cervical plexus block in humans: an anatomical study. Br J Anaesth. 91(5):733-5, 2003
                                                                          13. Castresana MR et al: Incidence and clinical significance of hemidiaphragmatic paresis in patients undergoing carotid endarterectomy during cervical plexus block anesthesia. J Neurosurg Anesthesiol. 6(1):21-3, 1994