Jon and I did this awesome ultrasound-guided superficial cervical plexus nerve block the other day for a R IJ central line placement– taught to us by none other than the amazing Dr. Otto Liebmann.
It was so neat we made a video about it. Check it out!
[youtube https://www.youtube.com/watch?v=gtWuDEV6fnQ&w=420&h=315]
Excellent job. Can’t wait to try. My only question…should you be concerned in a patient with respiratory compromise and risk of anesthetizing the phrenic nerve (which lies just on top of the scalene)? What is the actual risk of causing paralysis to half the diaphragm? How can we avoid this complication?
I think it is safe as long as you’re actually getting the superficial cervical plexus which is why identifying your landmarks and staying superficial (hugging the posterior edge of the SCM) are important. Paralyzing the diaphragm IS definitely a concern with doing an inter-scalene block.
Cervical plexus contents:
Cutaneous branches: Lesser occipital nerve, greater auricular, transverse cervical, supraclavicular
Muscular branches: ansa cervicalis, branches to posteriolateral neck
Fantastic! I will be watching this again–great resource, thanks Otto, Liz, Jon et al!
This is awesome. Will definitely be trying it out on my next central line insertion!
This is fantastic, so excited to give it a trial.