The Cervical Plexus

Question 1

What fascial compartments exist in the neck

Answer 1

Superficial cervical fascia

Deep cervical fascia split into…
- Investing fascia
- Pre-vertebral fascia
- Pre-tracheal fascia

Carotid sheath

Question 2

The superficial cervical plexus- Nerve roots

Answer 2

C1-C4 (anterior rami) and input from superior cervical sympathetic ganglion

Question 3

The superficial cervical plexus- Branches

Answer 3

• Lesser occipital
• Great auricular
• Transverse cervical
• Supraclavicular nerves

Question 4

The superficial cervical plexus- Supplies

Answer 4

The skin of the anterior and lateral regions of the neck.

Question 5

The route of the phrenic nerve

Answer 5

• Nerve roots C3-C5 (Mainly C4)
• forms at the lateral border of the anterior scalene muscle
• runs down this posterior to the sternocleidomastoid and the internal jugular vein
• through the thoracic inlet where it is joined by the accessory phrenic nerve
• passes to the diaphragm supplying all motor function to the muscle

Question 6

The deep cervical plexus- Nerve roots

Answer 6

C1-C4 (anterior rami) and input from superior cervical sympathetic ganglion

Question 7

The superficial cervical plexus- Supplies

Answer 7

• Most of the muscles in the neck anterior to the vertebral column
• Ansa cervicalis- all the infrahyoid muscles except thyrohyoid
• Sternocleinodmastoid, trapezius, levator scapulae, scalene muscles

Question 8

Superficial cervical plexus block

Answer 8

• Deposit LA in the middle third of the posterior border of the sternocleidomastoid
• Above the superficial cervical fascia
• Care should be taken to avoid the external jugular vein

Question 9

Deep cervical plexus block

Answer 9

• Patient positioned with head turned away
• Line drawn from mastoid process to transverse process of C6 (Chassaignac’s tubercle)
• C2, C3, C4 are marked along this line at 2, 4 and 6cm beneath the mastoid process
• LA to skin and sub cut at these points
• Insert needle at each point aiming caudad until contact is made with transverse process
• Withdraw 1-2mm, aspirate and inject 3-4ml of LA

Question 10

Intermediate cervical plexus block

Answer 10

• Patient positioned with head turned away
• USS identify the C4 transverse process then move forward and identify the sternocleidomastoid muscle
• Needle between sternocleidomastoid and anterior scalene muscle
• LA is infiltrated here

Question 11

Complications of the deep cervical plexus block

Answer 11

• Palsy of the phrenic, recurrent laryngeal, vagus and hypoglossal nerve
• Intravascular injection into the carotid or internal jugular
• Subarachnoid injection
• Horner’s syndrome (blocking sympathetic fibres of the cervical chain)

Question 12

Indications for cervical plexus block

Answer 12

• Carotid endarterectomy
• Thyroidectomy
• Clavicle fractures
• CVC insertion in the IJV