Blockade of a cervical plexus

Description:

Infiltration of skin. After processing of a surface of skin solution of an antiseptic agent makes infiltration of hypodermic cellulose on the line reflecting the provision of cross shoots of cervical vertebrae. Infiltration is carried out throughout the line, but not in points of estimated injections. It allows to change a point of introduction of a needle in the caudal and cranial direction if it is not possible to localize a cross shoot of a vertebra without additional infiltration of skin.

Introduction of a needle. The needle connected by a flexible tube to the syringe, sodezhashchy anesthetic solution is entered between fingers to the palpating hand moves ahead perpendicular to the surface of skin. The needle cannot be inclined at all kranialno. Some caudal direction - the best way to prevent unintentional introduction of a needle to the spinal channel. The needle moves ahead slowly before contact with a cross shoot of a cervical vertebra. At this moment the needle is tightened on 1-2 mm and strongly keeps in such situation, after aspiration test 4 ml of solution of places an anesthetic leg are entered. After that the needle is taken and all procedure repeats at the following level. Usually the contact with a cross shoot happens at a depth of 1-2 cm. This distance can be reduced with an external pressure upon the surface of a neck in a needle injection site. The needle has to be entered on depth more than 2.5 cm to avoid injury of a spinal cord, a puncture of a carotid or vertebral artery.

The purpose - contact of a needle with a cross shoot of the cervical vertebra located below. Spinal nerves are at the non-constant level in close proximity to a front surface of cross shoots. Some managements recommend receiving paresthesia, however paresthesia has nonspecific character and it is difficult to differentiate it from a local pain syndrome when carrying out a needle.

Failure in achievement of a cross shoot at the first popypytka. If in the first attempt of introduction of a needle it is not possible to receive contact with a cross shoot at a depth of 2 cm, then the following events are held:

1. The palpating hand in the same situation keeps. Skin in an injection site of a needle stretches between index and average fingers so that to avoid its shift on an extent in procedures.
2. The needle to skin level is tightened, bends by 15 degrees caudally and the attempt repeats.
3. The needle is removed, then it is entered on 1 cm caudally and again the attempt repeats.

Choice of local anesthetic. Deep blockade of a cervical plexus demands introduction of 3-5 ml of solution of local anesthetic on each level, except for patients with serious respiratory frustration (blockade of the Phrenic nerve). Use of drugs with long action is in most cases more preferable. Though carrying out deep blockade of a cervical plexus is connected with essential discomfort, it is necessary to avoid excessive sedation of the patient. During operations in a neck access to respiratory tracts is complicated owing to proximity of a surgery field. Operation, similar to a carotid endarterioektomiya, demand preservation of contact with the patient throughout all procedure. Besides, excessive sedation can lead to orientation loss, inadequate behavior of the patient that will create additional difficulties for surgeons. Terms of development of anesthesia at this equipment make 10-15 minutes.

The first manifestation of blockade is the anesthesia in a zone of an innervation of the corresponding branches of a cervical plexus. It should be noted that owing to the complex organization of an innervation of various structures of a neck and to existence of an anastomosis from the opposite side, anesthesia at blockade of a cervical plexus seldom happens full. However it should not be the cause for refusal of this technique. An exit - in interaction with the surgeon who as necessary supplements blockade with local administration of anesthetic.

Operations in the field of a carotid sine demand also blockade of branches of a glossopharyngeal nerve that is easily reached during operation of administration of solution of local anesthetic in a cover of a carotid artery.