Spread of injectate with superficial cervical plexus block in humans: an anatomical study
Spread of injectate with superficial cervical plexus block in humans: an anatomical study
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DOI：
10.1093/bja/aeg250
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发表时间：
2003-11-01
影响因子：
9.8
通讯作者：
Morris, JF
中科院分区：
文献类型：
--
作者：
Pandit, JJ;Dutta, D;Morris, JF
背景本研究旨在探讨颈浅丛阻滞在颈动脉内膜剥脱术中的有效性。初步考虑表明，浅表注射不太可能阻断相关神经的所有终末纤维。一种可能性是局麻药穿过颈深筋膜，阻滞了颈神经根部。在4具尸体上使用亚甲蓝（30 ml）进行颈浅神经丛阻滞（注射至筋膜下方）。在另外一具对照尸体中，进行了颈丛深部注射。在另一具对照尸体中，在胸锁乳突肌后缘进行皮下注射（覆盖筋膜表面）。解剖显示，浅表阻滞时，染料扩散到颈深筋膜下的结构。在第一个对照组中，染料保留在颈深间隙中。在第二个对照中，染料保持皮下。颈浅间隙与颈深间隙相通，这可以解释浅阻滞的有效性。通信方式仍然未知。我们的研究结果还表明，颈浅丛阻滞的合适注射部位是颈部筋膜下，而不仅仅是皮下。
Background. This study was undertaken to investigate why the superficial cervical plexus block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the deep cervical fascia and blocks the cervical nerves at their roots.Methods. Superficial cervical plexus blocks (injections just below the investing fascia) were performed using methylene blue (30 ml) in four cadavers. In one additional control cadaver, a deep cervical plexus injection was performed. In a second control cadaver, a subcutaneous injection (superficial to investing fascia) was performed at the posterior border of the sternomastoid muscle.Results. Anatomical dissection showed that with superficial block there was spread of the dye to structures beneath the deep cervical fascia. In the first control, dye remained in the deep cervical space. In the second control, dye remained subcutaneous.Conclusions. The superficial cervical space communicates with the deep cervical space and this may explain the efficacy of the superficial block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial cervical plexus block is below the investing fascia of the neck, and not just subcutaneous.