3.3 Cervical Plexus

Question 1

1. Describe the Cervical Plexus

Answer 1

Unification of:

4 upper cervical anterior nerve roots
sensory

Upper 5 cervical anterior anterior nerve roots
Motor

Broadly divided into motor and sensory

Question 2

4 Main branches Motor

Answer 2

1. Ansa Cervicalis roots
   C1-C3
   -Superior root C1
   Geniohyoid + thyrohyoid

-Inferior Root C2 C3
Omohyoid
sternothyroid
sternohyoid

2. Branch to longus capitis and Collis
   C2-C4
3. Phrenic Nerve
   C3-C5
   Motor to Diaphragm
4. Accessory CN
   C2-C5
   Motor to SCM + Trap

Question 3

4 Main sensory

Answer 3

1. Greater auricular N
2. TV Cervical N
3. Lesser Occipital N
4. Supraclavicular N

Root values C2-4 for all

Question 4

Regional Anaesthesia

Answer 4

Requires blockade of
superficial and deep cervical plexi

LA supplementation usually
required by surgeon @ Sheath

Question 5

Superficial Plexus Block

Answer 5

Infiltration along posterior border of SCM

Block: 
Lesser occipital 
Greater Auricular
Anterior cutaneous N
Supraclavicular N

Question 6

Deep Cervical Plexus Block

Locating

Answer 6

Patient turns head away
Neck Extended

Palpate Chaissaignacs tubercle @ cricoid level

Locate same point @ C2 - Inferior to mastoid
Draw line
-TV process of C3+C4 along line

Needle directed caudally _ medially
-relevant TV process encountered
Withdraw + aspirate

Question 7

Deep cervical plexus block

procedure

Answer 7

Test of ml LA
injected
Ensure correct placement
remain volume injected

2 Technique

1 - 1 Shot technique
C4 TV process
10-15ml LA injected

2 Multiple shot:
C2 / 3 / 4
TV process identified
3 separate needle 5ml LA injected at each level

Recent descriptions of USG
Require lower rates of surgical supplement

Nerve stim incorporated for occipital muscle response