An Anatomical Basis for Blocking of the Deep Cervical Plexus and Cervical Sympathetic Tract Using an Ultrasound-Guided Technique

• Published in: Anesthesia and analgesia Vol. 110; no. 3; pp. 964 - 968
• Main Authors: USUI, Yosuke, KOBAYASHI, Toshiya, KAKINUMA, Hiroyuki, WATANABE, Keisuke, KITAJIMA, Toshimitsu, MATSUNO, Kenjiro
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.2010
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Biological and medical sciences; Cadaver; Cervical Plexus - diagnostic imaging; Female; Humans; Injections; Male; Medical sciences; Neck Muscles - diagnostic imaging; Neck Muscles - innervation; Nerve Block - methods; Sympathetic Nervous System - diagnostic imaging; Tomography, X-Ray Computed; Ultrasonography, Interventional; Anesthesia
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ane.0b013e3181c91ea0

A selective blocking method for the cervical plexus and the cervical sympathetic trunk has not yet been established. We performed a detailed examination of the neck anatomy using 28 cadavers. The pattern of local anesthetic distribution after injection in 2 healthy volunteers was imaged using computed tomographic scan. The deep cervical plexus was located in the groove between the longus capitis and scalenus medius muscles. The cervical sympathetic trunk was located on the anteromedial surface of the longus capitis. Although anesthetic injected into the longus capitis was confined to the muscle, it infiltrated into neighboring structures including the C2 to C5 roots and sympathetic trunk. The longus capitis muscle is a suitable landmark for blocking the cervical plexus and trunk.