cervical plexus block.pptx

Cervical plexus block for thyroid surgeries the pain relief and management of such patients

1. Introduction It has been observed : *Pain after thyroid surgery is regarded as being of moderate intensity and short duration, however during the first 24 h after surgery patients require opioid and non-opioid analgesia. *Therefore use of regional anaesthesia may reduce the requirements of intraoperative fentanyl use and postoperative opioid analgesia. *BUPIVACAINE is one of the long acting local anaesthetics , belonging to the amide group . It has a higher potency for motor and sensory block than most other local anaesthetics such as ropivacaine and lignocaine. *CLONIDINE exerts its analgesic action by activating the alpha 2 adrenoceptors in the dorsal horn of spinal cord via systemic absorption from local site thereby reducing the sympathetic outflow from CNS and blocking pain transmission by reducing NE release. At the local site it directly acts by blocking release of substance P and CGRP release and reducing hypersensitivity by its anti-inflammatory action. Hence the additive action increases duration of analgesia.

2. *The Bilateral superficial cervical plexus block.   Given under general anaesthesia and before the incision is taken. Under landmark technique a line extending from the mastoid process to C6 is drawn. The site of needle insertion is marked at the midpoint of this line. This is where the branches of the superficial cervical plexus emerge from behind the posterior border of the sternocleidomastoid muscle.(the lesser occipital , greater auricular , transverse cervical and supraclavicular nerves.) After cleansing the skin with an antiseptic solution, a skin wheal is raised at the site of needle insertion, the local anesthetic is injected alongside the posterior border of the sternocleidomastoid muscle 2–3 cm below and then above the needle insertion site, just below the subcutaneous plane. The goal is to achieve block of all four major branches of the superficial cervical plexus.(the lesser occipital, greater auricular, transverse cervical and supraclavicular nerves.) Superficial cervical plexus block requires 10–15 mL of local anesthetic (3–5 mL per each redirection/injection). An initial injection of 3 mL local anesthetic is deposited at the midpoint of the sternocleidomastoid muscle( this blocks the transverse cervical nerve.), followed by 3-5 mL injected subcutaneously in a cephalad direction along the posterior boarder of the muscle (to block the greater auricular and lesser occipital nerves.) and caudad direction along the posterior border of the muscle.( to block the supraclavicular nerves.)