Ultrasound-Guided Blocks for Spine Surgery: Part 1-Cervix

Abstract

Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.

Keywords: multimodal analgesia; regional anesthesia; spine surgery.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1

Transverse sonogram of the lateral cervical area at the C4 level. The arrows indicate the needle trajectories for cervical plexus block: A—deep; B—superficial; C—intermediate. SCM—sternocleidomastoid muscle; IJV—internal jugular vein; CA—carotid artery; LCe—longus cervicis muscle; LCa—longus colli muscle; AT—anterior tubercle of transverse process; PT—posterior tubercle of transverse process.

Figure 2

Transverse sonogram of the posterior neck area at the C5 level. The arrows indicate the needle trajectories for: A—inter-semispinal plane block; B—retrolaminar cervical block; C—multifidus cervicis plane block; D—cervical erector spinae plane block. MC—multifidus cervicis muscle; SCe—semispinalis cervicis muscle; SCa—semispinalis capitis muscle; Sp—splenius muscle; Tr—trapezius muscle.

Figure 3

Cross-section of the neck at the level of C7/C8. The arrows indicate the needle trajectories for: A—inter-semispinal plane block; B—multifidus cervicis plane block; C—retrolaminar cervical block; D—cervical erector spinae plane block; E—medial transthyroid stellate ganglion block. 1—anterior jugular vein; 2—sternothyoid muscle; 3—thyroid gland; 4—common carotid artery; 5—sympathetic trunk; 6—sympathetic trunk; 7—external jugular vein; 8—longus colli muscle; 9—middle scalene muscle; 10—posterior scalene muscle; 11—levator scapulae muscle; 12—trapezius muscle; 13—serratus posterior superior muscle; 14—splenius capitis muscle; 15—rhomboid minor muscle; 16—platysma; 17—sternocleidomastoid muscle; 18—trachea; 19—vagus nerve; 20—internal jugular vein; 21—phrenic nerve; 22—vertebral artery; 23—cervical vertebra (C7); 24—Spinal nerves (C5, C6, and C7); 25—Spinal nerve root (C8); 26—First rib; 27—transverse process of vertebra; 28—multifidus muscle; 29—iliocostalis cervicis muscle; 30—longissimus cervicis muscle; 31—splenius cervicis muscle; 32—interspinous ligament. Scheme based on [67].

Figure 4

Transverse sonogram of the posterior neck area at the C6 level. The arrow indicates the needle trajectories for stellate ganglion block. SCM—sternocleidomastoid muscle; OM—omohyoid muscle; T—thyroid gland; CA—carotid artery; IJV— internal jugular vein; LC—longus colli muscle; LCa—longus capitis muscle; AS—anterior scalene muscle; TP—transverse process; AT—anterior tubercle of the transverse process; C6—C6 nerve root.