Cervical plexus anatomy and complications associated with cervical plexus nerve block
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Date
2023
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Plexus cervicalis bloks (PCB) nodrošina anestēziju un analgēziju galvas un kakla reģionā. PCB indikācijas ir karotīda ķirurģija, centrālā venozā katetrizācija, klavikulāra ķirurģija un lūzumi, limfmezglu ekscīzija anterior un posterior kakla anatomiskajos trīsstūros, vairogdziedzera un epitēlijķermenīšu ķirurģija, postoperatīvas sāpes pēc kakla operācijām.
Pētījuma mērķis bija izprast plexus cervicalis anatomiskās struktūras, izpētīt tam apkārtesošās struktūras, izmantojot laterālo pieeju. Mūsu mērķis bija atklāt potenciālās komplikācijas, kas varētu rasties šīs procedūras laikā individuālo anatomisko variāciju dēļ.
Lai izpētītu plexus cervicalis, tika izmantota laterālā pieeja cadaver dissekcijai (RSU Anatomijas un antropoloģijas institūtā, Morfoloģijas katedrā) un brīvprātīgu pētījuma dalībnieku fizikāla izmeklēšana.
Mēs izmeklējām cadaver un izpētījām anatomiskās struktūras un laterālo superficiālo, dziļo un vidēji dziļo pieeju.
Plexus cervicalis ir nervu pinums pirmo 4 cervikālo spinālo nervu anterior zarā, tas veidojas no cervikālo nervu segmentiem C1-C4. Tika veikta cadaver dissekcija virzienā no m.strenocleidomastoideus uz cervikālajiem skriemeļiem. Sākotnēji tika veikta ādas atpreperēšana, atklājot pinuma sensoros zarus. Turpmāk veicām m.platysma sedzošās superficiālās cervikālās fascijas atdalīšanu, turpinot ar dziļās cervikālās fascijas superficiālās un dziļās lapiņas, kā arī m.sternocleidomastoideus atdalīšanu. Tika atklāts ansa cervicalis. Turpinot dissekciju uz spinālo nervu anterior zara pusi, redzama iekšējā jugulārā vēna, kas atrodas bīstami tuvu nerviem. Aiz tās redzama kopējā karotīdā artērija. Tika atrastas arī atsevišķas, grūti diferencējamas nervu šķiedras, kas, iespējams, ir hipoglossālais, faciālais un glossofaringeālais nervs. Starp kopējo karotīdo artēriju un iekšējo jugulāro vēnu tika atrasts n.vagus, kas inervē iekšējos orgānus. Turpinot dissecēt m.scalenus anterior, tika sasniegts mūsu mērķis – spinālie nervi. Plexus cervicalis te sadalās motorajos zaros. Kopumā plexus cervicalis sadalās motorajos, sensorajos zaros un jauktajā zarā – n.phrenicus – kas sākas no cervikālo nervu segmentiem C3-C5.
Secinājumi: 1)Plexus cervicalis, ko mēs izpētījām, sakrita ar literatūrā aprakstīto 2)Anatomisko variantu dēļ ir svarīgi atrast individuālu pieeju katram pacientam 3) Plexus cervicalis iekļaujošās struktūras PCB laikā var tikt nejauši savainotas un izraisīt nopietnas procedūras komplikācijas.
The cervical plexus block (CPB) provides anesthesia and analgesia to the head and neck region. Indications for CPB are carotid surgery, central venous catheters, clavicular surgery or fractures, lymph node excision within the anterior and posterior triangles of the neck, thyroid and parathyroid surgery, postoperative pain after neck surgeries. Aim of the study was to understand the anatomical structure of cervical plexus, explore the positions of structures around it and the lateral approach. Our aim was to reveal the complications possible to occur in this procedure due to the variations in every individual. To examine cervical plexus, lateral approach cadaver dissection (RSU Institute of Anatomy and Anthropology, department of morphology) and examining willing participants was used. We dissected the cadaver and examined the anatomical structures and the lateral superficial, deep and intermediate approaches. The cervical plexus is a nervous plexus of the anterior rami of the first four cervical spinal nerves which arise from cervical nerve segments C1-C4. That is why we dissected from underneath the sternocleidomastoid muscle in direction to the cervical vertebrae. First, we dissected skin and discovered the sensory branches of the plexus. Next, we dissected the superficial cervical fascia which covers the platysma muscle. Going through the superficial layer of deep cervical fascia, which surrounds the sternocleidomastoid muscle, the deep layer of deep cervical fascia was found. This fascia envelopes the ansa cervicalis. Dissecting deeper towards the anterior root of spinal nerve, the internal jugular vein lies on the right side dangerously close to nerves. Behind it is the common carotid artery. We also discovered some nerve fibers which were hard to differentiate, but we believe were the hypoglossal, the facial, the glossopharyngeal nerves. Between the common carotid artery and the internal jugular vein was the vagus nerve, which innervates the internal organs. Next, we dissected the anterior scalene muscle, behind it we reached our goal - the spinal nerve. The cervical plexus is divided into the motor branches. Overall the plexus gives off motor, sensory branches and a mixed branch - the phrenic nerve, which starts from cervical nerve segments C3-C5. Conclusions: 1)The cervical plexus that we dissected coincides with what is described in literature. 2)Due to the anatomical variants in every patient it is crucial to find the individual approach for everyone. 3)The structures surrounding the cervical plexus can be accidently damaged which can cause serious side effects.
The cervical plexus block (CPB) provides anesthesia and analgesia to the head and neck region. Indications for CPB are carotid surgery, central venous catheters, clavicular surgery or fractures, lymph node excision within the anterior and posterior triangles of the neck, thyroid and parathyroid surgery, postoperative pain after neck surgeries. Aim of the study was to understand the anatomical structure of cervical plexus, explore the positions of structures around it and the lateral approach. Our aim was to reveal the complications possible to occur in this procedure due to the variations in every individual. To examine cervical plexus, lateral approach cadaver dissection (RSU Institute of Anatomy and Anthropology, department of morphology) and examining willing participants was used. We dissected the cadaver and examined the anatomical structures and the lateral superficial, deep and intermediate approaches. The cervical plexus is a nervous plexus of the anterior rami of the first four cervical spinal nerves which arise from cervical nerve segments C1-C4. That is why we dissected from underneath the sternocleidomastoid muscle in direction to the cervical vertebrae. First, we dissected skin and discovered the sensory branches of the plexus. Next, we dissected the superficial cervical fascia which covers the platysma muscle. Going through the superficial layer of deep cervical fascia, which surrounds the sternocleidomastoid muscle, the deep layer of deep cervical fascia was found. This fascia envelopes the ansa cervicalis. Dissecting deeper towards the anterior root of spinal nerve, the internal jugular vein lies on the right side dangerously close to nerves. Behind it is the common carotid artery. We also discovered some nerve fibers which were hard to differentiate, but we believe were the hypoglossal, the facial, the glossopharyngeal nerves. Between the common carotid artery and the internal jugular vein was the vagus nerve, which innervates the internal organs. Next, we dissected the anterior scalene muscle, behind it we reached our goal - the spinal nerve. The cervical plexus is divided into the motor branches. Overall the plexus gives off motor, sensory branches and a mixed branch - the phrenic nerve, which starts from cervical nerve segments C3-C5. Conclusions: 1)The cervical plexus that we dissected coincides with what is described in literature. 2)Due to the anatomical variants in every patient it is crucial to find the individual approach for everyone. 3)The structures surrounding the cervical plexus can be accidently damaged which can cause serious side effects.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Plexus cervicalis, nervu bloks, anestēzija, analgēzija, Cervical plexus, nerve block, anesthesia, analgesia