Cervical plexus block for thyroid surgeries the pain relief and management of such patients

2. INTRODUCTION
I T H A S B E E N O B S E R V E D :
* P A I N A F T E R T H Y R O I D S U R G E R Y I S R E G A R D E D A S B E I N G O F M O D E R A T E I N T E N S I T Y
A N D S H O R T D U R A T I O N , H O W E V E R D U R I N G T H E F I R S T 2 4 H A F T E R S U R G E R Y
P A T I E N T S R E Q U I R E O P I O I D A N D N O N - O P I O I D A N A L G E S I A .
* T H E R E F O R E U S E O F R E G I O N A L A N A E S T H E S I A M A Y R E D U C E T H E R E Q U I R E M E N T S
O F I N T R A O P E R A T I V E F E N T A N Y L U S E A N D P O S T O P E R A T I V E O P I O I D A N A L G E S I A .
* B U P I V A C A I N E I S O N E O F T H E L O N G A C T I N G L O C A L ANAESTHETICS, BELONGING TO THE AMIDE
GROUP. I T H A S A H I G H E R P O T E N C Y F O R M O T O R A N D S E N S O R Y B L O C K T H A N M O S T
O T H E R L O C A L A N A E S T H E T I C S S U C H A S R O P I V A C A I N E A N D L I G N O C A I N E .
* C L O N I D I N E E X E R T S I T S A N A L G E S I C A C T I O N B Y A C T I V A T I N G T H E A L P H A 2
A D R E N O C E P T O R S I N T H E D O R S A L H O R N O F S P I N A L C O R D V I A S Y S T E M I C
A B S O R P T I O N F R O M L O C A L S I T E T H E R E B Y R E D U C I N G T H E S Y M P A T H E T I C O U T F L O W
F R O M C N S A N D B L O C K I N G P A I N T R A N S M I S S I O N B Y R E D U C I N G N E R E L E A S E .
A T T H E L O C A L S I T E I T D I R E C T L Y A C T S B Y B L O C K I N G R E L E A S E O F S U B S T A N C E P
A N D C G R P R E L E A S E A N D R E D U C I N G H Y P E R S E N S I T I V I T Y B Y I T S A N T I -
I N F L A M M A T O R Y A C T I O N . H E N C E T H E A D D I T I V E A C T I O N I N C R E A S E S D U R A T I O N O F
A N A L G E S I A .

6. *The Bilateral superficial cervical plexus block.
Given under general anaesthesia and before the incision is taken.
 Under landmark technique a line extending from the mastoid process to C6 is drawn. The site of needle
insertion is marked at the midpoint of this line. This is where the branches of the superficial cervical plexus
emerge from behind the posterior border of the sternocleidomastoid muscle.(the lesser occipital , greater
auricular , transverse cervical and supraclavicular nerves.)
 After cleansing the skin with an antiseptic solution, a skin wheal is raised at the site of needle insertion, the
local anesthetic is injected alongside the posterior border of the sternocleidomastoid muscle 2–3 cm below and
then above the needle insertion site, just below the subcutaneous plane. The goal is to achieve block of all four
major branches of the superficial cervical plexus.(the lesser occipital, greater auricular, transverse cervical and
supraclavicular nerves.)
 Superficial cervical plexus block requires 10–15 mL of local anesthetic (3–5 mL per each redirection/injection).
 An initial injection of 3 mL local anesthetic is deposited at the midpoint of the sternocleidomastoid muscle( this
blocks the transverse cervical nerve.), followed by 3-5 mL injected subcutaneously in a cephalad direction
along the posterior boarder of the muscle (to block the greater auricular and lesser occipital nerves.) and
caudad direction along the posterior border of the muscle.( to block the supraclavicular nerves.)