A superficial cervical plexus block is a regional anaesthetic technique used to provide pain relief or numbness in the neck and upper shoulder region. It involves targeting the superficial cervical plexus, a network of nerves located near the side of the neck, which supplies sensation to the skin of the neck, jaw, ear, and portions of the shoulder. This block is commonly used in a variety of surgical and non-surgical settings due to its simplicity and effectiveness.
What is the Superficial Cervical Plexus?
The superficial cervical plexus is a part of the cervical plexus, which arises from the upper cervical spinal nerves (C1–C4). The superficial branches of this plexus include:
• Lesser occipital nerve: Supplies sensation to the scalp behind the ear.
• Greater auricular nerve: Provides sensation to the ear and the area over the parotid gland.
• Transverse cervical nerve: Supplies sensation to the anterior neck.
• Supraclavicular nerves: Provide sensation to the skin over the clavicle and upper shoulder.


Blocking this plexus can effectively manage pain in these regions.
Indications for a Superficial Cervical Plexus Block
Surgical anaesthesia or analgesia:
• Carotid endarterectomy (surgery on the carotid artery)
• Lymph node biopsy
• Thyroid or parathyroid surgery
• Minor neck procedure
Postoperative pain management:
After surgeries in the neck or shoulder area.
Chronic pain conditions:
Relief for persistent pain in the neck or shoulder caused by trauma or inflammation.
It is often chosen for its ability to provide localized anaesthesia without the systemic effects of general anaesthesia.
How the Procedure Works
A superficial cervical plexus block is typically performed as an outpatient procedure under ultrasound guidance to ensure precision. The steps include:
1. Preparation:
• The patient lies in a supine position with the head slightly turned to the opposite side.
• The skin is cleaned with an antiseptic solution, and a local anaesthetic may be applied to numb the injection site.
2. Identification of Landmarks:
• The injection site is located near the midpoint of the posterior border of the sternocleidomastoid muscle (a prominent neck muscle). Where the external jugular vein crosses the muscle.
• Ultrasound imaging is often used to visualize the cervical plexus and surrounding structures.
3. Injection:
• A thin needle is inserted at the targeted site, and a local anaesthetic is slowly injected into the tissue surrounding the superficial cervical plexus. The anaesthetic agent will be distributed deep into the fascia of the sternocleidomastoid muscle.
• Common anaesthetic agents include lidocaine, bupivacaine, or ropivacaine, which provide varying durations of anaesthesia.
4. Monitoring:
• The patient is observed briefly after the procedure to ensure no adverse reactions occur.
The procedure is quick, typically lasting around 10 to 15 minutes.
Benefits of a Superficial Cervical Plexus Block
• Effective pain relief: Provides targeted anaesthesia to the neck and shoulder region.
• Reduced need for general anaesthesia: Ideal for patients who are not candidates for general anaesthesia.
• Minimally invasive: The procedure is straightforward and involves minimal discomfort.
• Postoperative comfort: Helps manage postoperative pain effectively, reducing the need for systemic pain medications like opioids.
Risks and Potential Complications
While generally safe, superficial cervical plexus blocks carry some risks, including:
• Local reactions: Bruising, soreness, or infection at the injection site.
• Anesthetic complications: Rarely, the anaesthetic may spread to deeper structures, potentially causing unintended effects such as hoarseness (if the recurrent laryngeal nerve is affected) or temporary diaphragm weakness (if the phrenic nerve is affected).
• Systemic reactions: Rare allergic reactions or toxicity from the anaesthetic.
Proper technique and ultrasound guidance significantly reduce the likelihood of complications.
Who Can Benefit from This Procedure?
A superficial cervical plexus block is suitable for individuals undergoing specific neck or shoulder procedures, those with chronic pain in the region, or patients seeking alternatives to systemic anaesthesia. However, it may not be appropriate for patients with bleeding disorders, infections near the injection site, or allergies to local anaesthetics.
Conclusion
The superficial cervical plexus block is a valuable tool in modern medicine, offering effective and localized pain relief for various neck and shoulder conditions. Its minimally invasive nature, combined with its ability to reduce reliance on general anaesthesia or opioids, makes it an attractive option for both patients and healthcare providers. If you’re considering surgery or need pain management in the cervical region, consult with your healthcare provider to determine if a superficial cervical plexus block is right for you.
FAQs
General Questions
1. What is a superficial cervical plexus block?
It is a regional anaesthetic technique used to numb or reduce pain in the neck and upper shoulder region by targeting the superficial cervical plexus.
2. What conditions does it treat?
It is commonly used for surgeries like carotid endarterectomy, lymph node biopsies, thyroid or parathyroid surgery, and for managing chronic or postoperative pain in the neck and shoulder.
3. How long does the effect of the block last?
The duration depends on the anaesthetic used. Short-acting agents like lidocaine last a few hours, while long-acting ones like bupivacaine or ropivacaine can last up to 8-12 hours.
Safety and Risks
4. Is the procedure safe?
Yes, it is generally considered safe when performed by a trained professional under ultrasound guidance, though minor risks like bruising or soreness at the injection site exist.
5. What are the potential complications?
• Infection or bruising at the injection site
• Temporary hoarseness or difficulty breathing if the anaesthetic spreads to nearby nerves (rare)
• Allergic reaction to the anaesthetic (rare)
6. Will it affect my ability to breathe?
In rare cases, the anaesthetic can spread to the phrenic nerve, which may temporarily weaken the diaphragm. This is uncommon and usually resolves on its own.
Procedure Questions
7. Does the procedure hurt?
The procedure is minimally painful. A local anaesthetic is used to numb the injection site, so you may only feel slight pressure or a pinch.
8. How is the block administered?
A thin needle is inserted near the posterior border of the sternocleidomastoid muscle under ultrasound guidance, and an anaesthetic is injected into the targeted area.
9. How long does the procedure take?
The procedure typically takes 10-15 minutes, followed by a short observation period.
Effectiveness
10. How effective is the block for pain relief?
It is highly effective for providing localized pain relief in the neck and shoulder region, particularly for surgical and postoperative pain.
11. Will I need more than one block?
This depends on the condition being treated. For chronic pain, repeat blocks may be needed for long-term relief.
Preparation and Recovery
12. Do I need to prepare for the procedure?
Your doctor may ask you to avoid eating or drinking for a few hours beforehand and to inform them of any medications you are taking especially blood thinners.
13. What should I expect after the procedure?
• Temporary numbness or weakness in the neck or shoulder
• Pain relief starting immediately or shortly after the procedure
• You can usually resume normal activities on the same day unless advised otherwise.
14. Is there any downtime or recovery period?
Most people can go home shortly after the procedure and resume normal activities within a few hours.
Suitability
15. Am I a candidate for a superficial cervical plexus block?
It may not be suitable for individuals with bleeding disorders, infections near the injection site, or allergies to local anaesthetics. Your doctor will evaluate your medical history to determine suitability.
16. Can it be combined with other pain management techniques?
Yes, it is often part of a multimodal approach to pain management, which may include medications, physical therapy, or other interventions.
Cost and Availability
17. Is the procedure covered by insurance?
Most insurance plans cover cervical plexus blocks when medically necessary. It’s best to confirm with your provider.
18. Where can I get this procedure done?
The procedure is typically performed by anesthesiologists, pain management specialists, or surgeons in hospitals or outpatient clinics.