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The cervical plexus block is a regional anesthesia technique used for various surgical procedures and emergency department interventions involving the anterolateral neck, earlobe, clavicle, and acromioclavicular joint. This block provides dense anesthesia and analgesia in the distribution of C2 to C4 nerve roots. The technique can be performed using either a landmark-based or ultrasound-guided approach. The cervical plexus block requires proper patient positioning, sterile equipment, and local anesthetic administration alongside the posterior border of the sternocleidomastoid muscle. The superficial cervical plexus block significantly enhances patient care by providing effective pain management, reducing the need for systemic analgesics, and facilitating various procedures safely and expediently. This activity discusses the technique and clinical significance of the superficial cervical plexus block. Further, this activity also describes the role of the healthcare team in evaluating and managing care for patients who undergo this procedure. Effective interprofessional communication and coordination will be emphasized, ensuring seamless patient care and optimal outcomes. Overall, participation in this course enhances the team's competence in providing safe, patient-centered care through the application of the superficial cervical plexus block. Objectives: Identify the relevant anatomical landmarks and structures associated with the cervical plexus block procedure. Screen patients for appropriate candidates for cervical plexus block, considering their medical history, surgical needs, and complication risk factors. Apply evidence-based practices and guidelines in selecting patients for cervical plexus block, optimizing its use in various surgical and emergency scenarios. Collaborate with interprofessional teams, including clinicians, nurses, and pharmacists, to ensure seamless care coordination and patient safety throughout the cervical plexus block procedure. Access free multiple choice questions on this topic.

Regional anesthetic blocks constitute an integral component of a multimodal pain management strategy, frequently employed within emergency departments and perioperative clinical contexts. Preoperatively, such blocks find utility across a diverse spectrum of surgical procedures. In emergency department scenarios, their application facilitates procedures like inserting internal jugular central venous catheters, treating clavicular fractures, wound repair, and drainage of abscesses involving the earlobe and submandibular areas. The superficial cervical plexus block (CPB), in particular, confers ipsilateral anesthesia encompassing the anatomical region colloquially referred to as the "cape." This region delineates its boundaries by the posterior tip of the earlobe, the clavicle's lateral extremity, the mandible's medial aspect, and the clavicle's inferior surface.[1] Remarkably, CPBs are characterized by their ease of administration and proficiency in conferring anesthesia within the distribution spanning C2 to C4. This includes their applicability in procedures such as carotid endarterectomies, lymph node dissection, and plastic surgery.[2][3] Furthermore, the superficial CPB can be judiciously combined with the deep CPB to furnish comprehensive regional anesthesia, notably within the realm of oral and maxillofacial surgery.[4]

Complications may arise while administrating a CPB, with a higher incidence in deep blocks than superficial ones. An adequate understanding of the block's physiology and local anesthetic toxicity can mitigate these issues.[10] Superficial CPB shares common complications with other local anesthetic-based nerve blocks, including intravascular injection into a vein or artery, hematoma formation, infection risk, and local anesthetic toxicity. In contrast, deep CPB presents more severe complications, notably the inadvertent intravascular injection into the vertebral artery. This artery lies within the vertebral canal, situated approximately 0.5 cm below the tip of the transverse process, the anatomical landmark for local anesthetic deposition during deep CPB. Since the vertebral artery directly supplies blood to the brain, even a minute amount of local anesthetic can lead to central nervous system (CNS) effects as it swiftly reaches the brain. Therefore, maintaining continuous verbal contact with the patient during injection is crucial to promptly detect early signs of CNS toxicity, such as perioral numbness, disorientation, or tinnitus. Frequent aspiration should also be performed. With a slow injection rate and sustained patient communication, the progression of toxicity from the CNS to cardiac manifestations is highly improbable. Another concerning complication of deep CPB is subdural injection. Placing the needle too far can inadvertently penetrate the dural sleeve surrounding the nerve root, potentially resulting in a subarachnoid block leading to unconsciousness and hypotension. In such cases, endotracheal intubation and respiratory and cardiovascular support may become necessary.

Another concerning complication of deep CPB is subdural injection. Placing the needle too far can inadvertently penetrate the dural sleeve surrounding the nerve root, potentially resulting in a subarachnoid block leading to unconsciousness and hypotension. In such cases, endotracheal intubation and respiratory and cardiovascular support may become necessary. Furthermore, the cervical plexus is closely situated to large vessels (ie, the internal jugular vein and carotid artery) in the neck, and accidental vessel puncture may lead to significant hematoma formation.[5] Early recognition allows for local compression to alleviate the issue; however, in rare instances, when left unaddressed, it can lead to airway compromise. Additionally, unintentional deep injection or excessive local anesthetic volume can cause dysfunction and blockade of the recurrent laryngeal nerve, deep cervical plexus, and brachial plexus.[1] Accidentally blocking the accessory nerve can cause SCM and trapezius muscle weakness; this is also thought to cause phrenic nerve dysfunction, though a recent prospective randomized study found this untrue.[9]

Administering a CPB requires a multidisciplinary approach involving physicians, nurses, and pharmacists to ensure patient-centered care and optimize outcomes. Clinicians must possess the skills to perform the procedure accurately, adhering to stringent anatomical knowledge and precise techniques. Pharmacists ensure all medications used are not expired and correctly dosed. Nurses care for the patient before, during, and after the procedure, ensuring patient comfort and stability. Ethical considerations come into play when determining patient suitability for the block, weighing potential risks and benefits, and obtaining informed consent. Interprofessional communication between the clinician and the nurse is essential for comprehensive patient assessment, pre-procedural planning, and post-procedure monitoring, fostering a shared understanding of the patient's condition. Care coordination involves orchestrating the patient's journey from evaluation to recovery, including vigilant monitoring for potential complications. Collaborative teamwork ensures prompt response to adverse events and overall enhances patient safety. This collective effort aims to improve patient-centered care, minimize risks, and elevate team performance throughout the CPB procedure.