Milosevic Dragan, Sobot Novakovic Suzana, Djurdjevic Svraka Anita, Švraka Dragan
Anesthesiology and Critical Care, University Clinical Center of the Republic of Srpska, Banja Luka, BIH.
Surgery, Faculty of Medicine, University of Banja Luka, Banja Luka, BIH.
Cureus. 2024 Dec 27;16(12):e76495. doi: 10.7759/cureus.76495. eCollection 2024 Dec.
Cervical plexus block (CPB), like other types of regional anesthesia, represents an alternative anesthetic technique in those cases where the performance of general anesthesia (GA) carries an increased risk both for the patient and the outcome of the operative treatment. It has traditionally been used for years in carotid surgery as an alternative to GA, especially due to the possibility of superior monitoring - the awake patient. However, its effectiveness has been proven in other types of neck surgery, primarily in thyroid surgery, neck dissections, tracheostomy, central venous catheter insertion, clavicle surgery, etc. In most cases, it provides adequate and satisfactory analgesia of the anterolateral side of the neck (C1-C4 roots), at the same time avoiding all the negative effects on the patient that GA entails. Superficial block of the cervical plexus (SBCP) is a variant known for its simplicity and low number of complications. It can be performed traditionally with the help of external landmarks or with ultrasound-guided orientation. The case report describes the anesthesiology challenges of maintaining the airway caused by a high degree of compression by the retrosternal goiter and the possibility of performing such an operation under regional anesthesia. In this case, a male patient in his seventies presented with a giant retrosternal goiter and symptoms associated with tracheal compression. Due to significant tracheal narrowing, induction of general endotracheal anesthesia was not possible. The surgical treatment was performed through a low-collar incision with neck extension under bilateral superficial cervical plexus (BSCPB) block anesthesia. The study concludes that BSCPB can provide a satisfactory degree of analgesia for operative procedures like this, where GA poses a high risk.
颈丛阻滞（CPB）与其他类型的区域麻醉一样，在全身麻醉（GA）对患者和手术治疗结果均带来更高风险的情况下，是一种可供选择的麻醉技术。传统上，它多年来一直被用于颈动脉手术，作为全身麻醉的替代方法，特别是因为可以进行更好的监测——患者处于清醒状态。然而，其有效性已在其他类型的颈部手术中得到证实，主要是在甲状腺手术、颈部清扫术、气管切开术、中心静脉导管插入术、锁骨手术等中。在大多数情况下，它能为颈部前外侧（C1-C4神经根）提供充分且令人满意的镇痛效果，同时避免全身麻醉给患者带来的所有负面影响。颈浅丛阻滞（SBCP）是一种以操作简单和并发症少而闻名的变体。它可以传统地借助体表标志或在超声引导下进行定位。该病例报告描述了胸骨后甲状腺肿高度压迫导致气道维持方面的麻醉学挑战，以及在区域麻醉下进行此类手术的可能性。在这个病例中，一名七十多岁的男性患者患有巨大胸骨后甲状腺肿并伴有气管受压相关症状。由于气管明显狭窄，无法进行全身气管内麻醉诱导。手术治疗在双侧颈浅丛阻滞（BSCPB）麻醉下通过低领切口并伸展颈部进行。该研究得出结论，对于像这样全身麻醉风险高的手术，双侧颈浅丛阻滞可以提供令人满意的镇痛程度。
