Superficial Cervical Plexus Block During Internal Jugular Vein Cannulation for Pain Relief in Awake Patient

Background Internal jugular venous cannulation is required in many aspects for patients in intensive care, major surgeries, hemodialysis etc. Superficial cervical plexus block allows field of anesthesia to operate and secure the cannula in awake patient. Objective To study pain relief caused by superficial cervical plexus block of local anesthesia during the procedure of cannulation of internal jugular vein in patients requiring central venous cannulation. Method This prospective observational study was conducted from December 2023 to August 2024 at Dhulikhel Hospital, Kathmandu University Hospital. Sixty four awake patients with American Society of Anesthesia (ASA) I-III requiring central venous cannulation received ultrasound-guided Superficial cervical plexus block with 10 ml of 0.25% ropivacaine prior to internal jugular venous cannulation. Pain score (Verbal Pain Rating Scale) and hemodynamic changes (Heart rate, Mean Arterial Pressure, Spo2) were assessed at key procedural steps: during block, needle puncture, subcutaneous tunneling, catheter insertion, securing and suturing and five minutes post-procedure with any adverse effect and complication. Data were analysed using SPSS 22, student's unpaired t-test was applied to the continue statistical data and chi square test to the categorical test considering significance p value <0.05. Result All cannulations were successful on the first attempt. Only 1 patient (1.56)% required additional analgesia due to moderate pain during tunneling. Mean pain scores were minimal at all other stages (≤ 1). Hemodynamic parameters remained stable throughout the procedure, with no significant complications observed. Conclusion Ultrasound guided superficial cervical plexus block provides effective analgesia at various stages of procedure avoiding the complications. This study recommends Superficial block as one of the analgesic technique during awake internal jugular venous cannulation to improve patient comfort and procedural safety.