Superficial cervical plexus block for postop pain?

[Oggg]

---

Members don't see this ad.

Anyone doing superficial cervical plexus blocks and joking them for postop pain?

There is an ultrasound approach (called either superficial or intermediate cervical plexus block) that seems pretty easy. Typically used for awake CEA, but could be used for other indications: central line placement, vascath/permacath, pacemaker, clavicle surgery, shoulder surgery in conjunction with ISB, lymph node dissection, ACDC, thyroid. I suppose the shoulder surgery one is the one that might make some sense -- it would help block the skin near the shoulder and give anesthesia for a continuous ISB. Fredrikson does this combo all the time in new Zealand -- I wonder if anyone does it here and can bill for it. We have some cardiologists who try to place perm pacemakers and as a rule they suck with he local, so an SCB might help them out (probably couldn't bill for postop pain in that case)

 

[dhb]

I like the superficial cervical block, i do it a lot for carotids. It's maybe on of the blocks where ultrasound is a bit to cumbersome.
I think this technique is pretty sweet: i enter the skin a bit posterior to where you would go for stim guided ISB and look for a trapezius response and inject there. It really takes less than 2min to do.
As a resident i had a couple of unintended superficial blocks after an ISB when i confused the trapezius reponse with the deltoid.

 

[epidural man]

Anyone doing superficial cervical plexus blocks and joking them for postop pain?

There is an ultrasound approach (called either superficial or intermediate cervical plexus block) that seems pretty easy. Typically used for awake CEA, but could be used for other indications: central line placement, vascath/permacath, pacemaker, clavicle surgery, shoulder surgery in conjunction with ISB, lymph node dissection, ACDC, thyroid. I suppose the shoulder surgery one is the one that might make some sense -- it would help block the skin near the shoulder and give anesthesia for a continuous ISB. Fredrikson does this combo all the time in new Zealand -- I wonder if anyone does it here and can bill for it. We have some cardiologists who try to place perm pacemakers and as a rule they suck with he local, so an SCB might help them out (probably couldn't bill for postop pain in that case)

We always do the superficial after doing the deep for awake carotids.

I like to add them to ISB too.

 

[dhb]

I've done awake carotids with just the superficial block why do you do both?

 

[epidural man]

I've done awake carotids with just the superficial block why do you do both?

We also add an inferior alveolar nerve block as well. If you don't do this, sometimes when they do the higher up dissection and retraction, the patient is bothered and it is hard for the surgeon to supplement this.

I think the superficial probably works fine, but the surgeon will have to supplement a lot.

The deep is easy and quick - so it doesn't add much as far as time.

Who knows though, it may be that my deep isn't doing a think anyway and it is the superficial carrying the whole procedure.

 

[Oggg]

Ugh. I did ultrasound guided cervical plexus blocks by injecting 5-10cc local deep to the SCM at the midpoint of the SCM (from mastoid to clavicle, so about C3). All 3 patients got rapid onset numbness. These were all added to posterolateral ISB with ultrasound. Two of the three had SOB and chest heaviness for >6h. I never see that much phrenic paralysis with my ISBs. I think my ultrasound cervical plexus block must have nuked the phrenic nerves.