Test One Flashcards
4 nerves involved with superficial cervical plexus block.
Lesser occipital
Greater auricular
Supraclavicular
Transverse cervical
Indications for superficial cervical plexus block
Clavicular fractures
IJ vein cannulation
Soft tissue procedures over lateral neck, shoulder, and lower ear
Supplement deep cervical for carotid endarectomy
You can use USGRA or landmark based approach for superficial cervical block. TRUE/FALSE
TRUE
This is NOT used in superficial cervical block because all the nerves are sensory
Peripheral nerve stimulator
Injection point for superficial cervical block is right behind this muscle
SCM
This nerve has lateral, intermediate and medial branches that spread over the clavicle.
Supraclavicular nerve
Large vessel that lies over SCM, transverse cervical and supraclavicular nerve.
External jugular
For landmark based approach for superficial cervical block, block is placed midway between the ________ ________ and ________ along the posterior border of the ________ muscle; at the C___ level
Midway between mastoid process and clavicle
Posterior border of the SCM
C4 level
For superficial cervical block, what approach for use of US?
In plane, short axis
Under US, this muscle always points laterally when doing a superficial cervical block.
SCM
Where does the superficial cervical plexus lie ?
Between the two fascial planes below the SCM
What two muscles (lateral to medial) are one either side of the roots of the brachial plexus
Middle scalene
Anterior scalene
You should never go medial past roots of brachial plexus when doing superficial cervical block bc this nerve lies adjacent to anterior scalene muscle?
Phrenic nerve
What type of needle should you use for superficial cervical block?
Short beveled
22 gauge
LA and % needed for superficial cervical block
0.5% or less of bupivacaine/ropivacaine
In superficial cervical block, do a ______ml injection in a fan direction
5-10 ml
Superficial cervical block is often done in combination with an _______ block with the same needle pass.
Interscalene
Complications of superficial cervical plexus block
Nerve injury Seizures LAST Bleeding Inadvertent phrenic nerve blockade and/or Interscalene block (too ant.) High spinal or epidural
How might you get seizures when doing a superficial cervical block?
1-2 ml of LA injected into vertebral/carotid artery
What would be the result of a high spinal or epidural during superficial cervical plexus block?
Severe hypotension
Bradycardia
Respiratory arrest
Indications for Deep cervical plexus block?
- Carotid endarectomy
- Thyroid Sx (bil superfical cervical plexus only)
- removal of lymph nodes, nodules or small neck tumors
- clavicular fractures
- supplement to shoulder sx
- cervicogenic headaches
- disk herniation at C2-C4
What is the MAIN indication for deep cervical plexus blocks?
Carotid endarectomy
Deep cervical plexus block during carotid endarectomy allows for the determination of cerebral insufficiency during __________ and/or the need for ___________.
Carotid clamping
Shunting
Deep cervical plexus block also allows for better _________ stability during carotid endarectomy
Hemodynamic
Otherwise very labile BP and can have stroke