Last Updated on November 26, 2025 by Bilal Hasdemir

Managing pain in the neck and upper shoulder can be tough. A cervical nerve block is a special method. It targets the cervical plexus or its branches to help with pain.

At Liv Hospital, we mix trusted knowledge with academic standards. This way, we focus on our patients in cervical plexus blocks and other complex procedures. Our goal is to give patients all the support and guidance they need during their treatment.

Key Takeaways

• Understanding the anatomy involved in a cervical nerve block is key for managing pain.
• The technique needs precision and skill to hit the right nerves.
• Liv Hospital’s team approach means we give our patients full care for this procedure.
• Advanced regional anesthesia, like cervical blocks, brings big benefits for pain before and after surgery.
• Our practice puts patients first, making sure each one gets care that fits their needs.

Understanding Cervical Nerve Blocks

Learning about cervical nerve blocks is key for healthcare pros wanting to grow their pain management skills. These blocks are great for both figuring out and treating pain issues. They’re used in many ways to help manage pain.

Definition and Clinical Applications

A cervical plexus block means injecting local anesthetic around the cervical nerves. It’s used to numb pain during neck surgeries and for chronic pain. The superficial cervical plexus is important because it covers the skin of the neck.

Cervical nerve blocks are used in many ways. They help with pain before and after surgery and treat long-term pain. These blocks can really help improve a patient’s life.

Types of Cervical Nerve Blocks

There are different cervical nerve blocks, each for different needs. The main types are:

• Superficial Cervical Plexus Block: Targets the superficial branches for pain relief in the neck.
• Deep Cervical Plexus Block: Blocks deeper branches for more pain relief in complex cases.
• Intermediate Cervical Plexus Block: A mix of both, tailored for certain situations.

Benefits in Pain Management

Cervical nerve blocks have many benefits for pain management. They give strong pain relief without the side effects of pills. They also help find the source of pain, guiding treatment.

Using cervical plexus blocks can greatly help patients. It improves their pain management and quality of life.

Anatomy of the Cervical Plexus

Understanding the cervical plexus is key for anesthesiologists and pain specialists. It’s a complex network of nerves from C1 to C4.

Formation and Neural Pathways

The cervical plexus comes from the upper four cervical nerves (C1-C4). These nerves merge to form the plexus. It then branches out to innervate the neck’s structures.

The plexus has both motor and sensory fibers. Motor fibers control muscles, while sensory fibers handle skin and tissue sensation.

Superficial Cervical Plexus Anatomy

The superficial cervical plexus is in the neck’s posterior triangle. It provides sensory innervation to the neck and shoulder skin.

Its branches include the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves.

Deep Cervical Plexus Anatomy

The deep cervical plexus is deeper in the neck. It’s mainly for motor innervation. It supplies nerves to the neck muscles, like the sternocleidomastoid and trapezius.

Important Anatomical Landmarks

Key landmarks for finding the cervical plexus are the sternocleidomastoid muscle, scalene muscles, and cervical vertebrae’s transverse processes.

Here’s a quick summary of the cervical plexus anatomy:

Indications for Cervical Nerve Block

Knowing when to use cervical nerve blocks is key for good pain care. These blocks are great for neck procedures.

Perioperative Pain Management

Cervical nerve blocks are effective in managing perioperative pain for many surgeries. They cut down the need for strong pain meds, which can have bad side effects.

Using cervical blocks before surgery has many benefits:

• Less pain after surgery
• Less need for opioids
• Happier patients

Chronic Pain Conditions

Cervical nerve blocks can also help with chronic pain conditions in the neck. This includes pain from cervical radiculopathy and cervicogenic headache.

Specific Surgical Procedures

Cervical plexus nerve blocks are good for surgeries like lymph node biopsies and carotid endarterectomy. The superficial cervical block is best for surgeries in the front of the neck.

Understanding when to use cervical nerve blocks helps doctors manage pain better for their patients.

Contraindications and Risk Assessment

Choosing to do a cervical nerve block needs a deep look at its risks and when it’s not safe. We must check patients carefully. This makes sure the good parts of the procedure are worth the possible dangers.

Absolute Contraindications

Some things make a cervical nerve block a bad idea. These include:

• Patient Refusal: If the patient doesn’t want to do it.
• Local Infection or Sepsis: If there’s an infection at the site or in the body.
• Coagulopathy: If there’s a big problem with blood clotting, it could cause too much bleeding.
• Allergy to Local Anesthetics: If the patient is allergic to the drugs used in the block.

As noted by

“The use of local anesthetics in patients with a history of allergy requires careful consideration and alternative options should be explored.”

Relative Contraindications

Some issues might not stop a cervical nerve block but need extra thought. These include:

Patient Evaluation Protocol

Checking the patient well before a cervical nerve block is key. This means:

1. Looking over the patient’s medical history for any big no-nos.
2. Checking how the patient is doing now, including any health issues.
3. Talking about the risks and benefits with the patient and getting their okay.

Doctors pick local anesthetics like bupivacaine, usually in 0.25-0.5% strength. They choose based on how long the effect should last and what the procedure needs.

Equipment and Medications for Cervical Nerve Block

To do a cervical nerve block right, you need the right tools and medicines. The success and safety of the procedure depend on these.

Standard Equipment List

You’ll need sterile gloves, a sterile drape, and a local anesthetic needle for a cervical plexus block. Ultrasound guidance is key for better accuracy and safety.

• Sterile gloves and drapes
• Local anesthetic needles (22- to 25-gauge)
• Syringes (3 to 5 mL)
• Ultrasound machine with a linear probe

Local Anesthetic Agents

Choosing the right local anesthetic is vital for a successful block. Lidocaine, ropivacaine, and bupivacaine are common choices. The right one depends on how long you want the block to last and the patient’s health history.

Imaging Equipment Options

Ultrasound guidance is a big help for cervical plexus blocks. It lets you see the needle and the area around it in real time. This makes the block more precise and safer.

Fluoroscopy might be used too, if you need to check how the medicine spreads.

Patient Preparation and Positioning

Patient preparation is key in cervical nerve block procedures. It includes informed consent, the right position, and monitoring. We must focus on these steps to make sure the procedure is safe and works well.

Informed Consent Process

Getting informed consent is a big step before a cervical nerve block. We need to explain the procedure, its benefits, risks, and other options clearly. This helps the patient understand and make a good choice about their care.

The informed consent process includes:

• Explaining why and how the cervical nerve block works
• Talking about possible risks and side effects
• Discussing other options instead of the procedure
• Sharing what the patient can expect and the benefits

Optimal Patient Positioning

Getting the patient in the right position is important for a cervical nerve block. The patient should lie on their back with their neck a bit stretched. This makes it easier to reach the cervical area.

Monitoring Requirements

Keeping an eye on the patient is critical during a cervical nerve block. We need to watch their heart rate, blood pressure, and oxygen levels.

Tools for monitoring include:

1. Pulse oximeter
2. Blood pressure monitor
3. Electrocardiogram (ECG) machine

Aseptic Technique

Keeping everything clean is essential to avoid infections. We must follow strict cleaning rules and use only sterile tools.

By following these steps, we can make sure the cervical nerve block goes smoothly. This helps the patient get the best results and keeps risks low.

Superficial Cervical Plexus Block Technique

We will guide you through the steps of a superficial cervical plexus block. This procedure is used for both diagnosis and treatment. It helps manage pain in the neck and shoulder area.

Landmark-Based Approach

The landmark-based approach for a superficial cervical plexus block focuses on key anatomical landmarks. We find the midpoint of the posterior border of the sternocleidomastoid muscle. This is where the superficial cervical plexus is usually located.

To do this block, we first find the sternocleidomastoid muscle and its posterior border. A needle is inserted at the midpoint. Then, local anesthetic is given in a fan-like manner along the posterior border.

Ultrasound-Guided Technique

The ultrasound-guided technique is more precise for a superficial cervical plexus block. It uses ultrasound to see the needle and target area in real-time. This makes the procedure safer and more effective.

To start, we place the ultrasound probe transversely across the neck at the cricoid cartilage level. We identify the sternocleidomastoid muscle and the superficial cervical plexus. Then, we advance the needle under direct visualization.

Needle Insertion and Injection Technique

The needle insertion and injection technique is key to a successful block. The needle is inserted slowly, and aspiration is done before injecting local anesthetic. This avoids injecting into a blood vessel.

For both methods, we use a 25-gauge needle and inject 5-10 mL of local anesthetic. The injection is done slowly with gentle aspiration to avoid blood vessel injection.

CPT Coding and Documentation

Accurate CPT coding and documentation are vital for billing. The CPT code for a superficial cervical plexus block is usually 64415. But, coding can change based on the procedure and insurance needs.

We must document the procedure in detail. This includes the reason for the procedure, the technique used, the local anesthetic amount and type, and any complications. This documentation is important for patient care and billing.

Deep Cervical Plexus Block Technique

To do a deep cervical plexus block right, you need to know the key spots. This block is in the neck and helps with surgery and pain relief.

Anatomical Landmarks Identification

Finding the right spots is key for a good block. The sternocleidomastoid muscle and Chassaignac’s tubercle are important. These help guide the needle to the right spot.

Step-by-Step Procedural Guide

Here’s how to do a deep cervical plexus block step by step:

1. Put the patient on their back with their head turned to the side.
2. Find the sternocleidomastoid muscle and Chassaignac’s tubercle.
3. Put the needle behind the muscle at C6 level.
4. Move the needle until it hits the transverse process.
5. Check for blood or CSF by aspirating.
6. Then, inject the anesthetic.

Safety Considerations

Keeping the patient safe is top priority. Risks include bad injections, nerve harm, and toxicity. We use careful methods, right doses, and watch closely to avoid these.

Potential Challenges and Solutions

Even with careful planning, problems can happen. Issues include hard-to-find landmarks, hard needle advancement, and pain after. Solutions include ultrasound, adjusting the needle, and good care after.

Knowing the technique, landmarks, and challenges helps us do a deep cervical plexus block well. This makes patients more comfortable and the procedure a success.

Intermediate Cervical Plexus Block Approach

We use the intermediate cervical plexus block for pain relief in many cases. It’s known for helping with pain from cervical conditions.

Technical Description

This block involves injecting anesthetic into the cervical plexus at a certain level. It needs precise knowledge of anatomy and neural pathways. Ultrasound guidance makes it safer and more effective.

First, the patient is set up right, and the skin is cleaned. The ultrasound helps find the right spots, and the needle is placed carefully.

Advantages Over Other Approaches

The intermediate cervical plexus block offers targeted pain relief with fewer side effects. It’s good for patients at risk from bigger blocks.

It also has a better risk-benefit ratio for some patients. This makes it a key tool in pain management.

Clinical Applications

This block is used for neck and shoulder surgeries and chronic pain. Studies show it improves pain control and cuts down on pain meds.

Troubleshooting Tips

Practitioners might face issues like finding landmarks or placing the needle. Ultrasound guidance helps by showing what’s happening in real time.

Knowing the patient’s anatomy well is also key for success.

Ultrasound Guidance for Cervical Plexus Blocks

Ultrasound guidance has changed how we do cervical plexus blocks. It makes the procedure safer and more effective. The superficial cervical plexus block is often done with ultrasound. This lets us see the nerves and surrounding areas clearly.

Ultrasound Machine Settings

Choosing the right settings on the ultrasound machine is key. Start with a high-frequency linear probe (10-15 MHz) for detailed images. Adjust the depth to 2-4 cm to keep the target area in view. Make sure the gain is right to see the nerves and tissues well without too much brightness.

• Frequency: 10-15 MHz
• Depth: 2-4 cm
• Gain: Adjusted for optimal tissue visualization

Probe Selection and Positioning

The right ultrasound probe is essential for cervical plexus blocks. A high-frequency linear probe works best for clear images. Place the probe on the neck’s side, between the mastoid process and the clavicle. This lets you see the cervical plexus well.

Sonoanatomy of the Cervical Region

Knowing the sonoanatomy of the cervical area is vital. You need to spot the sternocleidomastoid muscle, scalene muscles, and cervical nerves. The cervical plexus is deep to the sternocleidomastoid muscle and beside the scalene muscles.

1. Identify the sternocleidomastoid muscle
2. Locate the scalene muscles deep to the sternocleidomastoid
3. Visualize the cervical nerves between the scalene muscles

Real-time Needle Visualization Techniques

Seeing the needle in real-time is key for ultrasound-guided blocks. We use an in-plane approach. This means the needle goes parallel to the probe, so you can always see it. This method makes the procedure safer by avoiding accidents.

Key tips for real-time needle visualization:

• Use a steep angle of insertion to improve needle visibility
• Adjust the probe to keep the needle tip in view at all times
• Use gentle movements to advance the needle under continuous ultrasound guidance

Potential Complications and Management

Cervical nerve blocks can have complications. It’s important to know about these risks. Understanding them helps keep patients safe and well cared for.

Common Complications

Common issues include temporary nerve damage, local anesthetic toxicity, and vasovagal reactions. These can be managed with the right care and watching the patient closely.

Nerve damage might happen from the needle or the anesthetic. It usually gets better in a few weeks. Toxicity from the anesthetic can cause serious problems like CNS toxicity or cardiovascular collapse. Vasovagal reactions can happen due to pain or stress during the procedure.

Serious Adverse Events

Rare but serious problems include spinal cord injury, vertebral artery puncture, and respiratory compromise. These can happen due to the procedure itself.

Spinal cord injury can be caused by the needle or the anesthetic. Puncturing the vertebral artery can lead to arterial dissection or intra-arterial injection of anesthetic. This can cause seizures or heart problems. Respiratory issues need quick action and might need supplemental oxygen or ventilatory support.

Prevention Strategies

Preventing problems starts with a good patient evaluation and risk assessment. Using ultrasound guidance can lower the risk of artery damage and improve where the anesthetic goes.

Following strict aseptic technique helps avoid infections. Being careful with the needle and slowly adding the anesthetic can prevent nerve damage and artery problems.

Management Protocols

Having a clear management protocol for problems is key. This means having resuscitation equipment ready and a team ready to act fast.

If a problem happens, acting quickly and correctly is vital. For example, lipid emulsion therapy is needed for anesthetic toxicity. Patients with respiratory issues might need oxygen or help with breathing.

Conclusion

Effective pain management is key for patient care. Cervical nerve blocks are a valuable tool in this area. We’ve looked at the anatomy, techniques, and uses of these blocks. They are important for both short-term and long-term pain relief.

Understanding the cervical plexus and mastering block techniques helps healthcare professionals. This targeted pain relief is very effective. Ultrasound guidance makes these procedures safer and more effective.

In conclusion, cervical nerve blocks are a valuable pain management tool. By using the knowledge and techniques from this article, healthcare professionals can improve patient care. This helps advance pain management practices.

FAQ

References

1. Neal, J. M., & Barrington, M. J. (2015). Cervical Plexus Block. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557382/