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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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Abi Lutfallah A, Jabbour K, Gergess A, Hayeck G, Matar N, Madi-Jebara S. [Cervical plexus block as an alternative anesthetic approach for type I thyroplasty: a case report]. Rev Bras Anestesiol 2020; 70:556-560. [PMID: 33012560 DOI: 10.1016/j.bjan.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/11/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. CASE REPORT A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia. An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. CONCLUSION The use of regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.
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Affiliation(s)
- Antoine Abi Lutfallah
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano.
| | - Khalil Jabbour
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
| | - Afrida Gergess
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
| | - Gemma Hayeck
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
| | - Nayla Matar
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Otolaryngology Head and Neck Surgery, Beirut, Líbano
| | - Samia Madi-Jebara
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
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Abi Lutfallah A, Jabbour K, Gergess A, Hayeck G, Matar N, Madi-Jebara S. Cervical plexus block as an alternative anesthetic approach for type I thyroplasty: a case report. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 33012560 PMCID: PMC9373069 DOI: 10.1016/j.bjane.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. Case report A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. Conclusion The use of a regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.
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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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Wang H, Ma L, Yang D, Wang T, Wang Q, Zhang L, Ding W. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: A randomized clinical trial. Medicine (Baltimore) 2017; 96:e6119. [PMID: 28207536 PMCID: PMC5319525 DOI: 10.1097/md.0000000000006119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery.From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed.Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased after GA, with highest degree at 8 hours postoperation; then the pain degree decreased, and the NRS was 1 at 24 hours postoperation. In group B, intraoperative pain was NRS 4, and pain degree decreased from 4 hours postoperation; the NRS was 2 at 24 hours postoperation. The incidence of severe PONV was higher in group A than that in group B. There was no significant difference in the spinal surgeon satisfaction and anesthetist satisfaction for the anesthetic techniques. There was significant difference in patient satisfaction between the 2 groups, with high satisfaction for GA.General anesthesia is superior to CPA in maintaining better intraoperative hemodynamic stability and providing high patient satisfaction with no intraoperative pain for patients receiving ACDF, but it entails longer surgery and anesthesia time, and requires more postoperative analgesic and anesthesia cost.
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Affiliation(s)
| | - Lei Ma
- Department of Spine Surgery
| | | | | | - Qian Wang
- Financial Statistics Office, The Third Hospital of HeBei Medical University
| | - Lijun Zhang
- The Orthopaedic Department From First Hospital of Shijiazhuang, Shijiazhuang, China
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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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Perisanidis C, Saranteas T, Kostopanagiotou G. Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery. Dentomaxillofac Radiol 2012; 42:29945724. [PMID: 22933534 DOI: 10.1259/dmfr/29945724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We examined the application of an ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in patients undergoing oral and maxillofacial surgery. METHODS A total of 19 patients receiving ultrasound-guided combined intermediate and deep cervical plexus anaesthesia followed by neck surgery were examined prospectively. The sternocleidomastoid and the levator of the scapula muscles as well as the cervical transverse processes were used as easily depicted ultrasound landmarks for the injection of local anaesthetics. Under ultrasound guidance, a needle was advanced in the fascial band between the sternocleidomastoid and the levator of the scapula muscles and 15 ml of ropivacaine 0.75% was injected. Afterwards, the needle was advanced between the levator of the scapula and the hyperechoic contour of the cervical transverse processes and a further 15 ml of ropivacaine 0.75% was injected. The sensory block of the cervical nerve plexus, the analgesic efficacy of the block within 24 h after injection and potential block-related complications were assessed. RESULTS All patients showed a complete cervical plexus nerve block. No patient required analgesics within the first 24 h after anaesthesia. Two cases of blood aspiration were recorded. No further cervical plexus block-related complications were observed. CONCLUSIONS Ultrasound-guided combined intermediate and deep cervical plexus block is a feasible, effective and safe method for oral and maxillofacial surgical procedures.
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Affiliation(s)
- C Perisanidis
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
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Abstract
This review will discuss the use of peripheral nerve blocks of the head and neck and its application to the practice of pediatric anesthesia using simple, landmark based approaches.
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Affiliation(s)
- Santhanam Suresh
- Children's Memorial Hospital, Department of Anesthesiology & Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, IL 60611, USA.
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The Use of the Superficial Cervical Plexus Block in the Drainage of Submandibular and Submental Abscesses—An Alternative for General Anesthesia. J Oral Maxillofac Surg 2008; 66:2642-5. [DOI: 10.1016/j.joms.2008.05.365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/17/2008] [Accepted: 05/13/2008] [Indexed: 11/18/2022]
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