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At least 19 recordsLinked to original sources
PubMed1991

Syndrome of the cervical plexus caused by high cervical nerve root compression.

Lesions affecting the roots of the cervical plexus can cause a syndrome not previously described. The C3-C4 disc space is the most likely to be involved, but pressure on the C5 root can also produce facial, auricular, or retroauricular pain. Motor innervation to the diaphragm can be affected, and even the uppermost disc space at C2-C3 might be implicated. Findings on examination findings are sparse, although sensory impairment in areas of cervical plexus innervation has been observed. In a series of 1000 cervical decompression cases (both anterior and posterior) for disc disease or similar processes, only 10 instances of this syndrome have been found. Paresthesia or episodic shock-like pain affecting the ear, para-auricular, lower occipital, and mandibular areas prompted by head turning or extension are the most common complaints.

Aged↗
PubMed1998

Incidence of phrenic nerve block and hypercapnia in patients undergoing carotid endarterectomy under cervical plexus block.

Deep cervical plexus blockade blocks the second, third and fourth cervical nerve roots. The phrenic nerve arises from C3, C4, C5 and should therefore be commonly blocked with cervical plexus blockade. The aim of this study was to report the incidence of phrenic nerve block and to assess the effect of this on arterial carbon dioxide tension (PaCO2) in premedicated and sedated patients. Forty patients were studied, blood gases being taken on the day before surgery, immediately before performing the block and then every 20 minutes until the operation was completed. Fluoroscopy was used to determine ipsilateral hemidiaphragmatic dysfunction due to phrenic nerve block. The patients were then divided into two groups of analysis. Group A patients had evidence of phrenic nerve block, Group B patients had no evidence of phrenic nerve block. Fluoroscopy showed that 22 patients (55%) had evidence of phrenic nerve block (Group A), 18 patients showed no change (Group B). PaCO2 levels increased in both groups following premedication, from 41 +/- 5 mmHg (mean +/- SD) to 46 +/- 5 mmHg in Group A, and 41 +/- 4 mmHg in Group B; twenty minutes after cervical plexus block the PaCO2 rose to 49 +/- 6 mmHg in Group A, and 48 +/- 6 mmHg in Group B. These changes were not statistically significantly different when the two groups were compared.

Aged↗
PubMed1997

The intradural cervical plexus. An absent cervical nerve root.

Whilst dissecting the intradural and peripheral pathways of the spinal accessory n. (Sp. XI) as part of a larger study into its microsurgical anatomy, we have discovered an unusual and previously unreported anatomical variant. In one cadaver the intradural C2 dorsal n. root was completely absent on the left side. Considerable speculation surrounds the function of the spinal accessory n. in human subjects. Recent anatomical and clinical studies have drawn attention to the intradural plexus-like morphology of the Sp. XI and raised the possibility of integration of pro-prioception and motor control of the neck musculature at this level. The general anatomy of the Sp. XI is reviewed along with current ideas from recent studies.

Accessory Nerve↗
PubMed1992

Extracapsular spread and the perineural extension of squamous cell cancer in the cervical plexus.

Extracapsular spread of squamous cell carcinoma in cervical lymph nodes is associated with approximately 50% decrease in survival and a twofold increase in regional recurrence. This study examines the hypothesis that increased regional recurrence may be, in part, due to unrecognized microscopic perineural invasion of the nerve rootlets of the cervical plexus. Thirty patients with head and neck squamous cell carcinoma with clinically N+ necks undergoing radical neck dissection were prospectively studied. Neck dissection specimens were evaluated for extracapsular spread, and the cervical plexus rootlets were histologically examined for perineural invasion. The incidence of extracapsular spread was 83% (25 of 30 patients). Only one (4%) of 25 had involvement of the cervical plexus, and this patient had gross as well as microscopic cervical plexus invasion. Microscopic perineural spread of squamous cell carcinoma in the cervical plexus occurs infrequently when extracapsular spread is present. Routine histologic evaluation of cervical rootlets for margins is warranted only when gross tumor is in close proximity to the cervical plexus.

Aged↗
PubMed1995

Superficial and deep cervical plexus block: technical considerations.

Regional anesthetic block of the cervical plexus is a safe and useful alternative to general endotracheal anesthesia for surgery of the neck, upper shoulder, and occipital scalp area. The sensory component of the cervical plexus can be blocked separately and easily by a superficial cervical plexus block. Both motor and sensory block can be obtained by deep cervical plexus block. Minor transient side effects are common to deep cervical plexus blocks, but they are rarely of any consequence. Recent years have seen an increase in interest in the use of the cervical plexus block, because its popularity for surgical procedures such as carotid endarterectomies has grown. An understanding of the anatomy and principles of this anesthetic technique will enable the clinician to offer the patient and surgeon an important anesthetic option.

Cervical Plexus↗
PubMed1995

A comparative ultrastructural study of primary afferents from the brachial and cervical plexuses to the external cuneate nucleus of gerbils.

The synaptic organisation of the primary afferents from the brachial and cervical plexuses to the external cuneate nucleus of gerbils was compared following an intraneural injection of horseradish peroxidase into the musculocutaneous, median, ulnar and radial nerves of the brachial plexus or the main branches of the cervical plexus; 407 labelled primary afferent terminals from the brachial and 459 from the cervical plexus were studied. These boutons made synaptic contacts with 586 and 633 dendritic profiles, respectively. 99.0% of the primary afferent boutons from the brachial plexus contained clear round synaptic vesicles (R boutons); the remaining 1% of boutons contained pleomorphic synaptic vesicles (P boutons). For boutons from the cervical plexus, 95% were R boutons and 5% were P boutons. The labelled R bouton profiles had a wide range of cross-sectional area from 0.4 to 13.1 microns 2, while the P boutonal profiles were of a small variety (range, 0.4-2.3 microns 2; mean, 1.5; S.D., 0.6 micron 2). The R boutons from the brachial plexus (mean, 3.9 microns; S.D., 2.1 microns 2) were generally larger than those from the cervical plexus (mean, 3.3 microns 2; S.D., 1.9 microns 2). On close analysis, 72.4% of R boutons from the brachial plexus were found to synapse on distal dendrites, 15.9% on secondary dendrites, 9.5% on dendritic spines and 2.2% on proximal dendrites. For R boutons from the cervical plexus, 81.1% synapsed on distal dendrites, 12.1% on dendritic spines and 6.8% on secondary dendrites; none was observed on proximal dendrites. Such a different synaptic organisation between the two nerve plexuses may be related to their different perceptuomotor executions.

Animals↗
PubMed1999

A comparison of two techniques for cervical plexus blockade: evaluation of efficacy and systemic toxicity.

UNLABELLED: We compared two techniques of cervical plexus blockade (CPB) for carotid endarterectomy. Cervical plexus nerve block was performed with a combination of bupivacaine and lidocaine, with injections at the C2-C3, C3-C4, and C4-C5 transverse processes in 11 patients (classical CPB) or with a single injection after localization of the cervical plexus with a nerve stimulator in 12 patients (interscalene CPB). Pain scores were obtained during block placement and at predetermined phases of the operation. Arterial blood was sampled before and 3, 5, 8, 10, 15, 25, 40, and 60 min after CPB for measurement of bupivacaine and lidocaine concentrations. Interscalene CPB was less painful than classical CPB. The techniques appeared equally effective. Patients in both groups required equivalent supplementation with IV fentanyl and additional local infiltration with lidocaine during the most painful stages of surgery. The maximal concentration of bupivacaine was lower in interscalene CPB compared with classical CPB (1.0 microg/mL versus 1.5 microg/mL, P < 0.01). The time required to reach the maximal concentration of bupivacaine was 15 (10-40) min in interscalene CPB and 10 (5-17) min in classical CPB (P < 0.05). Lidocaine maximal concentration was similar in both groups, however the time required to reach the maximal concentration was longer (P < 0.05) in interscalene CPB (15 [10-60] min) than in classical CPB (10 [8-20] min). We conclude that the interscalene CPB is as effective as the classical CPB as a regional technique for carotid endarterectomy and may be associated with a lower systemic absorption of bupivacaine. IMPLICATIONS: Cervical plexus blockade for carotid endarterectomy can be effectively performed with a single injection after localization of the cervical plexus with a nerve stimulator. This technique is simple and was associated with less systemic absorption of local anesthetic than the multiple-injection technique.

Aged↗
PubMedDate not supplied

Comparison of clonidine and epinephrine in lidocaine for cervical plexus block.

BACKGROUND AND OBJECTIVES: Carotid endarterectomy under cervical plexus block offers the advantage of awake neurologic assessment. The hypothesis was tested that the addition of clonidine 5 micrograms/mL to lidocaine 1.5% for the block is as effective clinically as the addition of epinephrine 5 micrograms/mL but without the associated tachycardia. METHODS: In a double-blind, randomized, prospective trial of 40 patients, local anesthetic solutions of lidocaine 1.5% containing either clonidine 5 micrograms/mL or epinephrine 5 micrograms/mL were compared for cervical plexus block in patients undergoing carotid endarterectomy. Each solution was administered to 20 patients with a total lidocaine dose of 7 mg/kg. The electrocardiogram, heart rate, and arterial pressure (radial artery catheter) were continuously monitored. Blood samples were drawn for determination of serum lidocaine levels during the first hour. RESULTS: The block onset time (8.4 +/- 0.6 minutes for epinephrine, 8.8 +/- 0.8 minutes for clonidine) and duration (139 +/- 6.7 minutes for epinephrine, 148 +/- 5.8 minutes for clonidine) were not different between the two groups. During the period from completion of the block until incision there was a significant heart rate increase in the epinephrine group (23% mean rise) as compared with the clonidine group (4% mean rise) (P < .003). There was no difference in blood pressure between the two groups. The maximum plasma concentrations of lidocaine were 2.5-7.6 micrograms/mL (mean, 4.5 +/- 0.3 micrograms/mL) for the epinephrine group and 4.7-18.4 micrograms/mL (mean, 7.5 +/- 0.7 micrograms/mL) for the clonidine group (P < .0002). The maximum concentrations were reached 0-30 minutes (mean, 8 +/- 1.4 minutes) after injection for the epinephrine group and 0-10 minutes (mean, 4.5 +/- 7.1 minutes) for the clonidine group (P < .03). CONCLUSIONS: Clonidine 5 micrograms/mL is a useful additive to lidocaine 1.5% for cervical plexus block to reduce the incidence of tachycardia; however, omission of epinephrine results in higher serum lidocaine levels.

Adrenergic alpha-Agonists↗
PubMed1984

Neurotization of avulsed roots of brachial plexus by means of anterior nerves of cervical plexus.

In summary, this technique provides a number of well-differentiated sensory and voluntary motor fibers. This number is certainly less than that of a normal plexus but is much more and of much better quality than that of intercostal nerves. If we distribute these fibers to well-chosen branches of the brachial plexus, limiting the neurotization to few selective components, we have the possibility of a useful recovery of essential movements of the shoulder and elbow. Sensation to the hand will also recover to a certain extent. Subsequent palliative operations (as for instance different kinds of arthrodesis) can supply a limb that, although paralyzed and severely impaired, can still be useful.

Arm↗
PubMed1998

Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery.

BACKGROUND: Carotid endarterectomy may be performed under cervical plexus block with local anesthetic supplementation by the surgeon as necessary during surgery. It is unclear, however, whether deep or superficial cervical plexus block offers the best operating conditions or patient satisfaction. Therefore, the authors compared the two in patients undergoing carotid endarterectomy. METHODS: Forty patients undergoing carotid endarterectomy were randomized to receive either a superficial or a deep cervical plexus block with 20 ml bupivacaine, 0.375%. Outcomes subjected to statistical analysis included supplemental anesthetic supplementation with lidocaine, 1%, by the surgeon, dermatomes affected by the block, paresthesia during block placement, postoperative pain scores, and analgesic requirements. RESULTS: Median supplemental lidocaine requirements were 6 ml (range, 0.5 to 20 ml) in the deep block group and 6 ml (range, 0 to 20 ml) in the superficial block group (P = 0.7323). Patients in the deep block group who reported paresthesia during block placement required less lidocaine supplementation (median, 2; range, 0.5 to 20 ml) than the 9.5 ml (range, 6 to 15.5 ml) required by those who did not experience paresthesia (P = 0.0113). Compared with patients in the superficial block group, those in the deep block group were less likely to need analgesia in the first 24 h after operation (P = 0.047), and those who required analgesia received it later (6.6 +/- 4.1 vs. 3.9 +/- 1.4 h after operation; Student's t test, P = 0.02). One patient in each group expressed dissatisfaction with the technique. CONCLUSIONS: Carotid endarterectomy may be performed satisfactorily during superficial or deep cervical plexus block placement with no differences in terms of supplemental local anesthetic requirements, although this is influenced by whether paresthesia is elicited during placement of the deep block. Therefore, the clinician's decision to use one block rather than another need not be based on any assumed superiority of one block based on intraoperative conditions or patient satisfaction.

Aged↗
PubMed2026

Superficial Cervical Plexus Block and Quality of Recovery after Thyroidectomy: A Randomized Clinical Trial.

BACKGROUND: Whether adding a bilateral superficial cervical plexus block to a thyroidectomy enhanced recovery pathway improves postoperative quality of recovery remains uncertain. METHODS: In a single-center prospective, randomized, double-blind, placebo-controlled trial in adults undergoing thyroidectomy with general anesthesia, participants were randomized to bilateral superficial cervical plexus blocks with 0.25% bupivacaine or saline. All participants received multimodal analgesia with dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, and incisional local anesthetic. The primary outcome was quality of recovery, measured by the QoR-40 survey, on postoperative day 1. Secondary outcomes included the need for rescue opioid, total opioid consumption, nausea, vomiting, antiemetic administration, length of stay in the postanesthesia care unit (PACU), and opioid use on postoperative day 1. RESULTS: A total of 160 participants were randomized to receive a superficial cervical plexus block with bupivacaine 0.25% (n = 78) or saline (n = 82). On postoperative day 1, mean QoR-40 scores were 174 (95% CI, 170 to 178) for bupivacaine and 173 (95% CI, 169 to 177) for saline. The adjusted mean difference between bupivacaine versus saline was 0.91 (95% CI, -3.57 to 5.40; P = 0.688). There were no significant between-group differences in the need for opioids in the PACU or on postoperative day 1, nausea, vomiting, or PACU length of stay. However, the total amount of opioid administered in the PACU was lower in the bupivacaine group (median [interquartile range], 0 [0 to 8]) compared with the saline group (2 [0 to 20]; Hodges-Lehmann location shift, 0 morphine milligram equivalents; 95% CI, -4 to 0; P = 0.017), and fewer participants in the bupivacaine group received rescue antiemetics (3 [3.8%] vs . 13 [16%]; difference, -12%; 95% CI, -22% to -1.8%; P = 0.011). CONCLUSIONS: Bilateral superficial cervical plexus blocks did not improve quality of recovery after thyroidectomy when added to a multimodal analgesic regimen including dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, and incisional local anesthetic but were associated with lower total PACU opioid consumption.

Humans↗