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Spinal Nerves: Plexus I01:22

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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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[Ultrasound-guided intermediate cervical plexus block. Anatomical study].

R Seidel1, M Schulze, K Zukowski

  • 1Klinik für Anästhesiologie und Intensivmedizin, HELIOS-Kliniken Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Deutschland, ronald.seidel@helios-kliniken.de.

Der Anaesthesist
|May 28, 2015
PubMed
Summary

This study identifies the C2-C4 compartment between cervical fascia layers as ideal for ultrasound-guided cervical plexus blocks. Dye spread confirms this target for intermediate blocks, avoiding the impermeable prevertebral fascia.

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Area of Science:

  • Anatomy
  • Regional Anesthesia
  • Ultrasound-Guided Procedures

Background:

  • Human cervical innervation is complex, with significant anatomical variability.
  • Cervical plexus blocks involve intricate networks including cervical and brachial plexuses, and cranial nerves.
  • Accurate targeting is crucial for effective and safe cervical plexus anesthesia.

Purpose of the Study:

  • To demonstrate the spread of injected solutions in anatomical preparations.
  • To identify a suitable target compartment for ultrasound-guided cervical plexus block.
  • To provide clinically relevant insights for performing cervical plexus blocks.

Main Methods:

  • Comparison of original anatomical dissections with existing literature.
  • Performance of intermediate ultrasound-guided cervical plexus blocks in three non-embalmed cadavers.
  • Injection of 20 ml methylene blue followed by dissection and photographic documentation of dye spread.

Main Results:

  • The target compartment was correctly identified in five out of six blocks.
  • Injectate spread cranio-caudally within the double layer of cervical fascia, permeating the superficial layer.
  • Anastomosis between the facial nerve (ramus colli) and cervical plexus (transverse cervical nerve) was consistently observed; the prevertebral lamina was impermeable.

Conclusions:

  • The fascial compartment between superficial and prevertebral layers is a suitable target for intermediate cervical plexus blocks (C2-C4 compartment).
  • Cranio-caudal spread facilitates needle guidance, and superficial layer permeability makes additional infiltration unnecessary.
  • The impermeable prevertebral lamina and observed facial nerve anastomosis offer insights into block efficacy and potential failure mechanisms.