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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; 15:e39303. [PMID: 37346207 PMCID: PMC10281613 DOI: 10.7759/cureus.39303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION In the present study, the advantages of superficial cervical plexus block (SCPB) were evaluated using a landmark-guided method. Our primary aim was to evaluate the analgesic efficacy of SCPB in various head and neck surgeries by observing intra- and postoperative requirements of the total dose of the systemic analgesic, visual analog scale (VAS) score, and the total duration of analgesia; vital parameters and associated perioperative complications were also observed. MATERIALS AND METHODS Sample size was calculated using reference by taking the parameter pain score at 12 hours using MedCalc software v. 19.5.1 (MedCalc Software, Ostend, Belgium) with a mean difference of score 3±3.5 between two groups, 80% power, and 95% confidence interval (CI); the sample size for each group was 21. There were 30 patients in each group of ASA I, II, and III who were posted for mandibular, tympanomastoid and clavicular surgeries. Group A received general anaesthesia with systemic analgesia and Group B received general anaesthesia followed by SCPB with an injection of bupivacaine 0.25% 10ml on each side according to the site of surgery. VAS score, intra and postoperative analgesic requirement in 24 hours, time of first demand bolus, and peri-operative complications were noted. RESULTS Intraoperative fentanyl requirement for group A was 97.5±13.75 µg as compared to group B (70.16±13.09 µg), postoperative injection paracetamol requirement was also significantly higher in group A (2566.66±504 mg) as compared to group B (833.33±874.28 mg). The total duration of analgesia was significantly higher in Group B (1191.33±375.36 min) as compared to Group A (122.0±50.88 min) with a p-value <0.0001. No significant complications were noted in any patient. CONCLUSION SCPB provides better perioperative analgesia by decreasing intraoperative as well as postoperative systemic analgesic requirements and their associated side effects, with no significant perioperative complications in various head and neck region surgeries.
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Affiliation(s)
- Himani Patel
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Neha Shah
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Afroza Syed
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Panjari Shah
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Sharmy Macwan
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
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Manaswini T, Girish T. U, Anil Kumar M. R. A Clinical Study on Neck Surgeries Under Superficial Cervical Plexus Block as an Alternative to General Anesthesia in High-Risk Cases. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Saripalli RRK, Kasaraneni S, Yadavilli SS, Alluri LSC. Superficial Cervical Plexus Block in Selective Cases of Oral and Maxillofacial Surgery as an Alternative to General Anesthesia: A Case Presentation. Cureus 2022; 14:e21371. [PMID: 35198283 PMCID: PMC8855022 DOI: 10.7759/cureus.21371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/21/2022] Open
Abstract
The superficial cervical plexus block (SCPB) is well acknowledged, accepted for regional anesthetic for the submandibular area, neck region, and ear lobe. It is a possible valuable anesthetic technique in individuals to be operated on with conditions such as ear lobe lacerations, submandibular abscesses, and trauma to the mandibular or the neck region. Its application in oral and maxillofacial surgery is for various surgical procedures in the peri-mandibular area, excision of superficial lesions in the mandibular, ear lobe, neck region, and suturing of the skin in the corresponding region. We illustrate a case of non-union of mandibular fracture operated under superficial cervical plexus block without any complications.
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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. J Oral Maxillofac Surg 2021; 79:2247-2256. [PMID: 34153248 DOI: 10.1016/j.joms.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections. METHODS A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals]. RESULTS Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes. CONCLUSION It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.
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Affiliation(s)
- Prajwalit Kende
- Head of Department, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Maroti Wadewale
- Resident, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai.
| | - Paul Mathai
- Ex-Assistant Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Jayant Landge
- Associate Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Harsh Desai
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai
| | - Vijayalaxmi Nimma
- Assistant professor, Department of Oral Medicine and Radiology, Government Dental College and Hospital, Mumbai
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The efficacy of maxillary and mandibular nerve blockade using electrical nerve stimulation for guidance. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:352-356. [PMID: 31568890 DOI: 10.1016/j.jormas.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In oral and maxillofacial surgical procedures, sometimes conventional loco-regional anesthesia techniques could be insufficient in daily clinical practice. The aim of this study was to evaluate the efficacy of analgesia using electrical nerve stimulation (ENS) for maxillary or mandibular nerve blockade, in comparison with conventional loco-regional anesthesia techniques. METHODS The study comprised 52 patients who were attending the department for advanced surgery of the upper and lower jaw. Patients were randomly divided into 2 groups: ENS and Local group. The predictor variable was the anesthesia technique (ENS and Local groups). The outcome variables were patient assessed pain levels (VAS scores) and total anesthetic dose. RESULTS Both the administered anesthetic dose and patient-assessed pain levels were significantly lower in the ENS group than in the Local group, despite there being no difference in age, sex or any hemodynamic parameters between the groups. CONCLUSIONS Maxillary and mandibular nerve blockade is more efficient with ENS guidance, with lower amounts of anesthetic required, compared to conventional loco-regional anesthesia.
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Surgical Management of Mandibular Subcondylar Fractures Under Local Anesthesia: A Proposed Protocol. J Oral Maxillofac Surg 2019; 77:1040.e1-1040.e9. [DOI: 10.1016/j.joms.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/15/2018] [Accepted: 01/01/2019] [Indexed: 11/29/2022]
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Rahman T, Ahmed S, Rahman S. Decompression of Ludwig's angina in a pregnant patient under bilateral superficial cervical plexus block. J Perioper Pract 2019; 32:66-68. [PMID: 30810488 DOI: 10.1177/1750458919834195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ludwig's angina is defined as a potentially lethal, rapidly spreading cellulitis, involving the sublingual and submandibular spaces, and is manifested by a brawny suprahyoid induration, tender swelling in the floor of the mouth, and elevation and posterior displacement of the tongue. During a life-threatening infection such as Ludwig's angina, the mother and foetus are vulnerable to septicemia and asphyxia. We describe a case of decompression of Ludwig's angina in a 28 weeks pregnant patient under bilateral superficial cervical plexus block. The block, coupled with bilateral mandibular nerve block, provided ample anaesthesia to perform a thorough incision and drainage, including transection of mylohyoid with lowering of the floor of mouth and rapid relief of respiratory obstruction.
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Affiliation(s)
- Tabishur Rahman
- Department of OMFS, Aligarh Muslim University, Aligarh, India
| | - Syed Ahmed
- Department of OMFS, Aligarh Muslim University, Aligarh, India
| | - Sajjad Rahman
- Department of OMFS, Aligarh Muslim University, Aligarh, India
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Ho B, De Paoli M. Use of Ultrasound-Guided Superficial Cervical Plexus Block for Pain Management in the Emergency Department. J Emerg Med 2018; 55:87-95. [PMID: 29858144 DOI: 10.1016/j.jemermed.2018.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although use of the superficial cervical plexus block (SCPB) by anesthesia for perioperative indications is well described, there is a paucity of research on use of SCPB in the emergency department (ED). OBJECTIVE This prospective observational study aims to prospectively characterize the feasibility, potential for efficacy, and safety of ultrasound-guided SCPB in a convenience sample of ED patients presenting with painful conditions of the "cape" distribution of the neck and shoulder. METHODS Data were gathered prospectively on a convenience sample of 27 patients presenting to a community ED with painful conditions involving the distribution of the SCPB: para-cervical muscle spasm/pain (n = 8), clavicle fractures (n = 7), acromioclavicular joint injuries (n = 3), radicular pain (n = 3), and rotator cuff disorders (n = 6). Pre- and post-block 11-point verbal numeric pain scores (VNPS) were recorded, as was the incidence of any immediate complications. A retrospective chart review looked for delayed complications in the 14-day post-block period. RESULTS The mean 11-point VNPS reduction was 5.4 points (62%). There were no early serious complications and one case each of self-limiting vocal hoarseness and asymptomatic hemi-diaphragmatic paresis. No delayed block-related complications were found. CONCLUSIONS While limited by the fact that this was a nonrandomized observational experience with no control group, our findings suggest that SCBP may be safe and have potential for efficacy, and warrants further evaluation in a randomized controlled trial.
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Affiliation(s)
- Ben Ho
- Emergency Department, Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Nanaimo, British Columbia, Canada
| | - Michael De Paoli
- Department of Family Medicine, University of British Columbia, Nanaimo, British Columbia, Canada
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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 2017; 18:23-29. [PMID: 30728687 DOI: 10.1007/s12663-017-1029-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022] Open
Abstract
Aim To assess the safety and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. Subjects and Methods The total number of patients was 10, out of which 6 were male and 4 were female patients. Five patients had incision and drainage of perimandibular space infections, two patients had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture, and two patients had submandibular lymph node biopsies. Informed & written consent were obtained from the patients after they had the procedure explained to them. Medically compromised patients and those who were excessively anxious and apprehensive, patient who did not want the procedure to be done under regional anesthesia, and patients with a history of allergy to local anesthetic were excluded. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon under the supervision of anesthesiologist with continuous monitoring. Results SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study. Conclusion Superficial cervical plexus block anesthesia is a safe and useful anesthetic technique with the low risk of accidents and complications, thus a good alternative for regional anesthesia in selected cases in oral and maxillofacial surgery.
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Affiliation(s)
- Tajamul Ahmad Hakim
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Ajaz Ahmad Shah
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Zahoor Teli
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Shahid Farooq
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Shamina Kosar
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Mubashir Younis
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital Srinagar, Srinagar, Jammu and Kashmir India
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Kavrut Ozturk N, Kavakli AS, Sagdic K, Inanoglu K, Umot Ayoglu R. A Randomized Controlled Trial Examining the Effect of the Addition of the Mandibular Block to Cervical Plexus Block for Carotid Endarterectomy. J Cardiothorac Vasc Anesth 2017; 32:877-882. [PMID: 29397291 DOI: 10.1053/j.jvca.2017.06.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although the cervical plexus block generally provides adequate analgesia for carotid endarterectomy, pain caused by metal retractors on the inferior surface of the mandible is not prevented by the cervical block. Different pain relief methods can be performed for patients who experience discomfort in these areas. In this study, the authors evaluated the effect of mandibular block in addition to cervical plexus block on pain scores in carotid endarterectomy. DESIGN A prospective, randomized, controlled trial. SETTING Training and research hospital. PARTICIPANTS Patients who underwent a carotid endarterectomy. INTERVENTIONS Patients scheduled for carotid endarterectomy under cervical plexus block were randomized into 2 groups: group 1 (those who did not receive a mandibular block) and group 2 (those who received a mandibular block). The main purpose of the study was to evaluate the mandibular block in addition to cervical plexus block in terms of intraoperative pain scores. MEASUREMENTS AND MAIN RESULTS Intraoperative visual analog scale scores were significantly higher in group 1 (p = 0.001). The amounts of supplemental 1% lidocaine and intraoperative intravenous analgesic used were significantly higher in group 1 (p = 0.001 and p = 0.035, respectively). Patient satisfaction scores were significantly lower in group 1 (p = 0.044). The amount of postoperative analgesic used, time to first analgesic requirement, postoperative visual analog scale scores, and surgeon satisfaction scores were similar in both groups. There was no significant difference between the groups with respect to complications. No major neurologic deficits or perioperative mortality were observed. CONCLUSIONS Mandibular block in addition to cervical plexus block provides better intraoperative pain control and greater patient satisfaction than cervical plexus block alone.
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Affiliation(s)
- Nilgun Kavrut Ozturk
- Department of Anaesthesiology and Reanimation, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey.
| | - Ali Sait Kavakli
- Department of Anaesthesiology and Reanimation, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
| | - Kadir Sagdic
- Department of Cardiovascular Surgery, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
| | - Kerem Inanoglu
- Department of Anaesthesiology and Reanimation, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
| | - Raif Umot Ayoglu
- Department of Cardiovascular Surgery, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
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Kanthan RK. The use of superficial cervical plexus block in oral and maxillofacial surgical practice as an alternative to general anesthesia in selective cases. Ann Maxillofac Surg 2016; 6:4-8. [PMID: 27563598 PMCID: PMC4979341 DOI: 10.4103/2231-0746.186120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: (1) To assess the feasibility, safety, and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. (2) To assess any associated complication specifically related to the procedure. Subjects and Methods: The total number of patients was 10, out of which 6 were male and 4 were female patients. Six patients had incision and drainage of perimandibular space infections, two patients had Level Ib cervical lymph node biopsies, one patient had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture. Informed written consent was obtained from the patients after they had the procedure explained to them. Exclusion criteria included patient's refusal to undergo the procedure under regional anesthesia, allergy to local anesthetic, excessively anxious, and apprehensive patients, significant upper airway compromise warranting an endotracheal intubation to secure airway. All patients had the procedure done by the same operating surgeon. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon with satisfactory anesthesia and analgesia without any complication. Results: SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study. Conclusion: The notable anesthetic effect and adequate working time, summed with the low risk of accidents and complications, make this technique a good alternative for sensitive blockage of part of the cranial and cervical regions and have positive outcomes in selective OMFS cases.
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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; 2:79-84. [PMID: 27480473 DOI: 10.1016/j.janh.2016.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/02/2015] [Accepted: 01/15/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Accessory innervation (AI) may account for the persistent sensation perceived after successful mandibular anesthesia in the adult patient. The purpose of this systematic review was to record the quality of evidence pertaining to the cervical plexus (CP) AI in dental anesthesia. MATERIALS AND METHODS Electronic and manual searches were conducted using Ovid and Medline of articles published from 1922 to March of 2015. Studies written in any language were included as long as they involved: (i) humans, animals, and/or cadavers AND (ii) anatomical and/or research anesthetic-technique approaches and/or clinical approaches. Exclusion criteria were (i) maxillary buccal infiltration, (ii) no abstract/paper available, (iii) studies that do not comprise the description of the branches of the CP branches in dentistry and (iv) duplicated articles. The articles were reviewed and graded by levels of evidence (LOE) through a methodological scoring index (MSI). RESULTS Forty-four out of 185 papers fulfilled the inclusion criteria. One randomized control trial, 3 comprehensive reviews, 1 cohort study, 5 case series/reports, 16 poor-quality cohort and case series/reports and 18 reviews/case, reports/expert opinions were found. Of the 44 publications, there were 4 LOE 1, 1 LOE 2, 5 LOE 3, 20 LOE 4 and 14 LOE 5 studies. CONCLUSIONS The MSI helped to classify papers LOE in a standardized and objective approach. The objective evidence quality occurrence recorded was found to be LOE 4 (n = 20) > LOE 5 (n = 14) > LOE 3 (n = 5) > LOE 1 (n = 4) > LOE 2 (n = 1). The anatomy of the CP needs to be reexamined and understood in the anatomical literature.
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Affiliation(s)
- S Kim
- Department of Endodontology, Temple University Kornberg School of Dentistry, Philadelphia, PA, 19140.
| | - D Uzbelger Feldman
- Department of Endodontology, Temple University Kornberg School of Dentistry, Philadelphia, PA, 19140
| | - J Yang
- Department of Oral & Maxillofacial Radiology Director, Temple University Kornberg School of Dentistry, Philadelphia, PA, 19140
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Lee H, Jeon Y. Treatment of herpes zoster with ultrasound-guided superficial cervical plexus block. J Dent Anesth Pain Med 2015; 15:247-249. [PMID: 28879287 PMCID: PMC5564162 DOI: 10.17245/jdapm.2015.15.4.247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022] Open
Abstract
Herpes zoster most commonly occurs in elderly patients, and usually affects sensory neurons. Therefore, its characteristic symptoms are segmental pain, itching, and sensory changes in the affected areas. A 71-yr-old woman experienced painful herpetic rash on the right cervical 2-4 dermatomes for 16 days. Two days after the onset of the rash, she was diagnosed with herpes zoster, and prescribed 250 mg famciclovir three times a day for 7 days, pregabalin 150 mg twice a day, and tramadol 150 mg once a day for 14 days, by a dermatologist. Despite medication, her pain was rated at an intensity of 6/10 on the numeric rating scale. In addition, she complained of severe itching sensation on the affected dermatomes. Superficial cervical plexus block (SCPB) was performed at the right C4 level with 15 ml 0.5% lidocaine plus triamcinolone 30 mg. Five days after the procedure, pain and itching completely disappeared. SCPB may be an effective option for the treatment of acute pain and itching arising from herpes zoster, and for the prevention of postherpetic neuralgia.
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Affiliation(s)
- Hyerim Lee
- Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Younghoon Jeon
- Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
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Abstract
Regional anesthesia is the most effective procedure for acute pain therapy. Whether neuraxial and peripheral blocks in patients with pre-existing infectious conditions, immune deficits or other risk factors increase the risk of additional infections is unclear. Analyzing the available literature currently seems to indicate that the incidence of severe infectious complications is generally low. Diabetes, steroid therapy or malignant diseases are apparently present in many cases in which infections associated with regional anesthesia and analgesia have been described. A strict contraindication in patients with pre-existing systemic or local infections seems unjustifiable. A clear and documented risk-benefit ratio in these patients is mandatory.
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The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med 2011; 30:1263-7. [PMID: 22030184 DOI: 10.1016/j.ajem.2011.06.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022] Open
Abstract
The ultrasound-guided superficial cervical plexus (SCP) block may be useful for providers in emergency care settings who care for patients with injuries to the ear, neck, and clavicular region, including clavicle fractures and acromioclavicular dislocations. The SCP originates from the anterior rami of the C1-C4 spinal nerves and gives rise to 4 terminal branches--greater auricular, lesser occipital, transverse cervical, and suprascapular nerves--that provide sensory innervation to the skin and superficial structures of the anterolateral neck and sections of the ear and shoulder. Here we describe an ultrasound-guided technique for blockade of the SCP that is potentially well suited to emergency care settings. We present the first case description of its successful use to manage pain for a patient with an acute clavicle fracture. This case is presented to highlight one of several potential applications of this promising new technique in the emergency department.
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