CERVICAL PLEXUS NERVE BLOCK: A REVIEW OF TECHNIQUES AND APPLICATIONS IN ORAL AND MAXILLOFACIAL SURGERY
Abstract
The Cervical Plexus Nerve Block (CPNB) presents a viable alternative to general anesthesia (GA), offering numerous advantages including cost-effectiveness, reduced physiological stress, and lower complication rates. This review delves into the anatomy, classification, and varying techniques of CPNB, such as superficial, deep, and intermediate blocks, and their specific applications in oral and maxillofacial surgery. While CPNB has been effectively utilized in several head and neck procedures, its role in oral and maxillofacial surgery is gaining attention due to its potential to improve patient comfort and reduce opioid dependency. Despite these benefits, the technique does carry risks, particularly with deeper blocks, such as hemi-diaphragmatic dysfunction and respiratory distress. The review concludes that CPNB is a crucial component in the field of regional anesthesia for head and neck surgeries, advocating for further research and clinical application to enhance its safety and efficacy.
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References
McQueen K, Coonan T, Ottaway A, Dutton RP, Nuevo FR, Gathuya Z, et al. Anesthesia and Perioperative Care. In: Disease Control Priorities, Third Edition (Volume 1): Essential Surgery. The World Bank; 2015. p. 263–77.
Dohlman L, Kwikiriza A, Ehie O. Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings. Local Reg Anesth. 2020 Oct;Volume 13:147–58.
Shteif M, Lesmes D, Hartman G, Ruffino S, Laster Z. The Use of the Superficial Cervical Plexus Block in the Drainage of Submandibular and Submental Abscesses—An Alternative for General Anesthesia. Journal of Oral and Maxillofacial Surgery. 2008 Dec;66(12):2642–5.
Hakim TA, Shah AA, Teli Z, Farooq S, Kosar S, Younis M. The Safety and Effectiveness of Superficial Cervical Plexus Block in Oral and Maxillofacial Surgery as an Alternative to General Anesthesia in Selective Cases: A Clinical Study. J Maxillofac Oral Surg. 2019 Mar 26;18(1):23–9.
Kende P, Wadewale M, Mathai P, Landge J, Desai H, Nimma V. Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice. Journal of Oral and Maxillofacial Surgery. 2021 Nov;79(11):2247–56.
Telford RJ, Stoneham MD. Correct nomenclature of superficial cervical plexus blocks. Br J Anaesth. 2004 May;92(5):775–6.
Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications †. Br J Anaesth. 2007 Aug;99(2):159–69.
Syal K, Chandel A, Goyal A, Sharma A. Comparison of ultrasound-guided intermediate vs subcutaneous cervical plexus block for postoperative analgesia in patients undergoing total thyroidectomy: A randomised double-blind trial. Indian J Anaesth. 2020;64(1):37.
Pandit JJ, Dutta D, Morris JF. Spread of injectate with superficial cervical plexus block in humans: an anatomical study † †Presented in part at the Anaesthetic Research Society Meeting, Leeds, July 6, 2001. Br J Anaesth. 2003 Nov;91(5):733–5.
Nash L, Nicholson HD, Zhang M. Does the Investing Layer of the Deep Cervical Fascia Exist? Anesthesiology. 2005 Nov 1;103(5):962–8.
Shiv Kumar Singh. The cervical plexus: anatomy and ultrasound guided blocks. Anaesthesia Pain & Intensive Care . 2015;19:323–32.
Li J, Szabova A. Ultrasound-Guided Nerve Blocks in the Head and Neck for Chronic Pain Management: The Anatomy, Sonoanatomy, and Procedure. Pain Physician. 2021 Dec;24(8):533–48.
Guidera AK, Dawes PJD, Fong A, Stringer MD. Head and neck fascia and compartments: No space for spaces. Head Neck. 2014 Jul 29;36(7):1058–68.
Herring AA, Stone MB, Frenkel O, Chipman A, Nagdev AD. The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med. 2012 Sep;30(7):1263–7.
Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug 1;71(4):274–88.
Opperer M, Kaufmann R, Meissnitzer M, Enzmann FK, Dinges C, Hitzl W, et al. Depth of cervical plexus block and phrenic nerve blockade: a randomized trial. Reg Anesth Pain Med. 2022 Apr;47(4):205–11.
Masters RD, Castresana EJ, Castresana MR. Superficial and deep cervical plexus block: technical considerations. AANA journal. 1995 Jun;63:235.
Tran DQH, Dugani S, Finlayson RJ. A Randomized Comparison Between Ultrasound-Guided and Landmark-Based Superficial Cervical Plexus Block. Reg Anesth Pain Med. 2010 Nov;35(6):539–43.
Nerurkar AA, Laheri V V, Karnik HS, Mohite SN. Fluoroscopy guided cervical plexus block for carotid endarterectomy - a case report. Indian J Anaesth. 2009 Jun;53(3):352–4.
Zeidan A, Hayek F. Nerve stimulator‐guided cervical plexus block for carotid endarterectomy. Anaesthesia. 2007 Mar 12;62(3):299–300.
Kim HY, Soh EY, Lee J, Kwon SH, Hur M, Min SK, et al. Incidence of hemi-diaphragmatic paresis after ultrasound-guided intermediate cervical plexus block: a prospective observational study. J Anesth. 2020 Aug 31;34(4):483–90.
Chen X, Han C, Li D, Zhu F, Huang Y. Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment. J Cosmet Dermatol. 2024 Feb 25;23(2):470–8.
Perisanidis C, Saranteas T, Kostopanagiotou G. Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery. Dentomaxillofacial Radiology. 2013 Feb;42(2):29945724.
Koshy R, Thankamony H. Superficial cervical plexus block for urgent tracheostomy. Indian J Anaesth. 2019;63(1):65.
Patel H, Shah N, Syed A, Shah P, Macwan S. Evaluating the Analgesic Efficacy of Superficial Cervical Plexus Block for Head and Neck Surgeries: A Comparative Randomized Control Study. Cureus. 2023 May 21;
Lee H, Jeon Y. Treatment of herpes zoster with ultrasound-guided superficial cervical plexus block. J Dent Anesth Pain Med. 2015;15(4):247.
Kim S, Feldman DU, Yang J. A Systematic Review of the Cervical Plexus Accessory Innervation and Its Role in Dental Anesthesia. J Anesth Hist. 2016 Jul;2(3):79–84.
Weiss A, Isselhorst C, Gahlen J, Freudenberg S, Roth H, Hammerschmitt N, et al. Acute respiratory failure after deep cervical plexus block for carotid endarterectomy as a result of bilateral recurrent laryngeal nerve paralysis. Acta Anaesthesiol Scand. 2005 May 15;49(5):715–9.
Canbaz S, Turgut N, Halici U, Balci K, Ege T, Duran E. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study. BMC Surg. 2004 Dec 14;4(1):2.
Flores S, Riguzzi C, Herring A, Nagdev A. Horner’s Syndrome after Superficial Cervical Plexus Block. Western Journal of Emergency Medicine. 2015 May 1;16(3):428–31.
