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 to 45 ±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.

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ANALGESIC EFFICACY OF COMBINATION OF BILATERAL SUPERFICIAL CERVICAL PLEXUS BLOCK AND STANDARD ANALGESIA WITH STANDARD ANALGESIA ALONE IN PATIENTS UNDERGOING THYROID CANCER SURGERY. A RANDOMISED-CONTROLLED TRIAL

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v5i2.218 ◽

2019 ◽

Vol 5 (2) ◽

Author(s):

Hammad Nabeel Najeeb ◽

Ahsan Waqar Khan ◽

Athar Mukhtar Siddiqui

Keyword(s):

Thyroid Cancer ◽

Controlled Trial ◽

Analgesic Efficacy ◽

Cervical Plexus ◽

Group A ◽

Superficial Cervical Plexus Block ◽

Cervical Plexus Block ◽

Group B ◽

Randomised Controlled ◽

Plexus Block

Purpose: This study aimed to determine analgesic efficacy of a combination of bilateral superficial cervical plexus block (BLSCPB) and standard analgesia with standard analgesia alone in patients undergoing thyroid cancer surgery under general anaesthesia.Materials and Methods: It was a randomised-controlled trial conducted at the Anaesthesia Department of the Shaukat Khanum Memorial Cancer Hospital, Lahore. A sample size of 60 patients (30 patients in each group) was calculated with 95% confidence interval and power of 80%.Results: The mean pain-free duration for the Group A (BLSCPB group) was 72 min (SD 30.1) compared to 53 min (standard deviation 30.3) for the Group B. This shows a significant reduction in pain-free duration in Group A. Average NRS pain score in the Group A at q 0, 30, 60, 90 and 120 min was (0.83, 1.83, 0.23, 1.76 and 1.49), whereas the average pain score on NRS in the Group B at the same time interval mentioned above for Group A was (2.1, 2.73, 4.53, 2.44 and 1.85)Conclusion: Administration of BLSCPB resulted in superior analgesia after thyroid cancer surgery.Key words: Analgesia, cervical plexus block, post-operative pain, regional anaesthesia, thyroidectomy

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Ultrasound-guided superficial cervical plexus block for analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach: study protocol of a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-034003 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034003

Author(s):

Kun Peng ◽

Min Zeng ◽

Jia Dong ◽

Xiang Yan ◽

Dexiang Wang ◽

...

Keyword(s):

Nerve Block ◽

Rating Scale ◽

Numerical Rating Scale ◽

Controlled Trial ◽

Control Group ◽

Cervical Plexus ◽

Ethics Review ◽

Superficial Cervical Plexus Block ◽

Cervical Plexus Block ◽

Plexus Block

IntroductionScalp nerve block has been proven to be an alternative choice to opioids in multimodal analgesia. However, for the infratentorial space-occupying craniotomy, especially the suboccipital retrosigmoid craniotomy, scalp nerve block is insufficient.Methods and analysisThe study is a prospective, single-centre, randomised, paralleled-group controlled trial. Patients scheduled to receive elective suboccipital retrosigmoid craniotomy will be randomly assigned to the superficial cervical plexus block group or the control group. After anaesthesia induction, superficial cervical plexus nerve block will be performed under the guidance of ultrasound. The primary outcome is the cumulative consumption of sufentanil by the patient-controlled intravenous analgesia pump within 24 hours after surgery. Secondary outcomes include the cumulative consumption of sufentanil at other four time points and numerical rating scale pain severity score.Ethics and disseminationThe protocol (version number: 2.0, 10 April 2019) has been approved by the Ethics Review Committee of China Registered Clinical Trials (Ethics Review No. ChiECRCT-20190047). The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberNCT04036812

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Superficial Cervical Plexus Block Combined with Auriculotemporal Nerve Block for Drainage of Dental Abscess in Adults with Difficult Airways

Anaesthesia and Intensive Care ◽

10.1177/0310057x0903700118 ◽

2009 ◽

Vol 37 (1) ◽

pp. 124-126 ◽

Cited By ~ 3

Author(s):

K. U. Ling ◽

M. Shahnaz Hasan ◽

K. O. Ha ◽

C. Y. Wang

Keyword(s):

Nerve Block ◽

Cervical Plexus ◽

Dental Abscess ◽

Superficial Cervical Plexus Block ◽

Cervical Plexus Block ◽

Difficult Airways ◽

Plexus Block ◽

Auriculotemporal Nerve

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The Incidence and Aetiology of Phrenic Nerve Blockade Associated with Supraclavicular Brachial Plexus Block

Anaesthesia and Intensive Care ◽

10.1177/0310057x7900700406 ◽

1979 ◽

Vol 7 (4) ◽

pp. 346-349 ◽

Cited By ~ 75

Author(s):

G. E. Knoblanche

Keyword(s):

Brachial Plexus ◽

Nerve Block ◽

Phrenic Nerve ◽

Brachial Plexus Block ◽

X Ray ◽

Supraclavicular Approach ◽

True Incidence ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block ◽

Phrenic Nerve Block

A trial to ascertain the true incidence of inadvertent phrenic nerve block with brachial plexus block via the supraclavicular approach was carried out. Phrenic nerve block was monitored by x-ray screening of the diaphragm. There was an incidence of phrenic nerve block of 67% (10 cases of diaphragmatic paralysis in 15 brachial blocks). The possible causes of phrenic nerve block with brachial block are discussed. It is concluded that the phrenic nerve is blocked peripherally in front of the scalenus anterior.

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Mandibular Nerve Block in Addition to Cervical Plexus Block for Carotid Endarterectomy

Anesthesia & Analgesia ◽

10.1213/00000539-199811000-00011 ◽

1998 ◽

Vol 87 (5) ◽

pp. 1034-1036

Author(s):

Denis L. Bourke ◽

Padmini Thomas

Keyword(s):

Carotid Endarterectomy ◽

Nerve Block ◽

Mandibular Nerve ◽

Cervical Plexus ◽

Cervical Plexus Block ◽

Plexus Block

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Effect of Anaesthesiologists’ Experience on Preferred Technique and Volume of Local Anaesthetic Administered for Brachial Plexus Nerve Block: A Retrospective Observational Analysis

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47606.14639 ◽

2021 ◽

Author(s):

Depinder Kaur ◽

Reena Mahajan ◽

Shiv Kumar Singh ◽

Suchitra Malhotra

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Failure Rate ◽

Nerve Block ◽

Local Anaesthetic ◽

Block Group ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Group A ◽

Group B

Introduction: Faculty and Residents are trained in peripheral nerve blocks guided by blind technique, Peripheral Neuro Stimulator (PNS) or Ultrasound (USG) guided technique. But due to unavailability of USG machine in all institutes and requiring special training, techniques used for peripheral nerve blocks vary from institute to institute. Aim: To analyse the effect of anaesthesiologists’ experience on preferred technique and Local Anaesthetic (LA) volume used for brachial plexus nerve block retrospectively. Materials and Methods: In this retrospective observational study, 129 adults American Society of Anesthesiologists (ASA) grade I and II patients requiring brachial plexus nerve block for upper limb orthopaedic surgical anaesthesia for both elective and emergency surgery were divided into three groups for each year depending on technique for nerve block used. Group A: Received USG guided (Micromaxx Sonosite Inc, USA) brachial plexus nerve block. Group B: Received peripheral nerve stimulator (Inmed) guided brachial plexus nerve block. Group C: Received brachial plexus nerve block by traditional anatomical landmark based paraesthesia elicitation blind technique. Patients with inadequate surgical analgesia were given general anaesthesia and were categorised as failure rate. Year wise demographic data, type of technique used for giving brachial plexus nerve block, volume of drug used, failure rate, complications observed were collected and analysed by Student’s t-test and Chi-square test. Results: USG guided technique was the most prefered technique in both years (57.6%, n=38 in year 2018 and 49.2%, n=31 in year 2019). In remaining nearly half of the patients PNS and blind technique was used (PNS 24.2%, n=16 in year 2018 and 20.6%, n=13 in year 2019; blind technique 18.2%, n=12 in year 2018 and 30.2%, n=19 in year 2019). Significantly, less volume of LA drug (mL) was used in group A in year 2019 (16.43±6.07) than in year 2018 (22.34±4.75) (p<0.001). Failure rate in group A in year 2019 (3.2%) was significantly less than in year 2018 (5.2%), but the difference was insignificant in all three groups. In group A, no complications were observed in year 2019 while one incidence of hemidiaphragm paralysis was observed in year 2018, while in group B and C, complications were observed in both years. Conclusion: USG guided nerve block was the most preferred technique for nerve block in the study institute. In 24 months observation period, with increasing experience with USG there was significant increase in success rate and decrease in the volume of LA administered and complications.

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Depth of cervical plexus block and phrenic nerve blockade: a randomized trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102851 ◽

2022 ◽

pp. rapm-2021-102851

Author(s):

Mathias Opperer ◽

Reinhard Kaufmann ◽

Matthias Meissnitzer ◽

Florian K Enzmann ◽

Christian Dinges ◽

...

Keyword(s):

Lung Function ◽

Phrenic Nerve ◽

Mri Contrast Agent ◽

Complication Rates ◽

Superficial Fascia ◽

Cervical Plexus ◽

Nerve Blockade ◽

Diaphragmatic Motion ◽

Cervical Plexus Block ◽

Plexus Block

Background and objectivesCervical plexus blocks are commonly used to facilitate carotid endarterectomy (CEA) in the awake patient. These blocks can be divided into superficial, intermediate, and deep blocks by their relation to the fasciae of the neck. We hypothesized that the depth of block would have a significant impact on phrenic nerve blockade and consequently hemi-diaphragmatic motion.MethodsWe enrolled 45 patients in an observer blinded randomized controlled trial, scheduled for elective, awake CEA. Patients received either deep, intermediate, or superficial cervical plexus blocks, using 20 mL of 0.5% ropivacaine mixed with an MRI contrast agent. Before and after placement of the block, transabdominal ultrasound measurements of diaphragmatic movement were performed. Patients underwent MRI of the neck to evaluate spread of the injectate, as well as lung function measurements. The primary outcome was ipsilateral difference of hemi-diaphragmatic motion during forced inspiration between study groups.ResultsPostoperatively, forced inspiration movement of the ipsilateral diaphragm (4.34±1.06, 3.86±1.24, 2.04±1.20 (mean in cm±SD for superficial, intermediate and deep, respectively)) was statistically different between block groups (p<0.001). Differences were also seen during normal inspiration. Lung function, oxygen saturation, complication rates, and patient satisfaction did not differ. MRI studies indicated pronounced permeation across the superficial fascia, but nevertheless easily distinguishable spread of injectate within the targeted compartments.ConclusionsWe studied the characteristics and side effects of cervical plexus blocks by depth of injection. Diaphragmatic dysfunction was most pronounced in the deep cervical plexus block group.Trial registration numberEudraCT 2017-001300-30.

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