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Head and Neck Regional Anesthesia

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Essentials of Regional Anesthesia

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Abstract

Head and neck blocks provide reliable surgical anesthesia for a variety of neurosurgical, ophthalmological, and otolaryngological procedures. Additionally they serve as important techniques for awake intubation. In this chapter, landmark based technqiues are primarily described. It is through understanding of anatomy and innervation that safe and effective block placement can occur regarless of technique (palpation, landmark, ultrasound).Even though head and neck blocks are among the easiest to perform due to constant and reliable landmarks, they are still infrequently used by anesthesiologists in the operating room. This is in part because general anesthesia offers a safe and easy alternative for most surgeries involving these anatomical areas. Nonetheless, neural blockade has become the mainstay of anesthetic techniques for (a) most ophthalmologic cases, (b) neurosurgical procedures or carotid endarterectomies where intraoperative neurological assessment is required, and (c) a safe alternative for patients with low functional reserve that would have a poor tolerance to general anesthesia. These blocks can also prove to be useful for the anesthesiologists themselves, in techniques for airway management in awake patients.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

    Desiree Persaud BSc, MD, FRCPC

  2. Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Sébastien Garneau MD, DMV, FRCPC

Authors
  1. Desiree Persaud BSc, MD, FRCPC
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  2. Sébastien Garneau MD, DMV, FRCPC
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Corresponding author

Correspondence to Desiree Persaud BSc, MD, FRCPC .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    All of the following nerves must be blocked in order to provide anesthesia/analgesia to the scalp EXCEPT:

    1. (a)

      Cranial nerve V

    2. (b)

      Greater occipital nerve

    3. (c)

      Supraorbital nerve

    4. (d)

      Lesser auricular nerve

  2. 2.

    Compared to retrobulbar block the peribulbar block has the following property:

    1. (a)

      More complete akinesia of the eye

    2. (b)

      Uses less volume

    3. (c)

      More likely to have globe perforation.

    4. (d)

      Faster onset time

  3. 3.

    The superficial branches of the cervical plexus include the following nerves EXCEPT:

    1. (a)

      Lesser occipital nerve

    2. (b)

      Greater auricular nerve

    3. (c)

      Suprascapular nerve

    4. (d)

      Transverse cervical nerve

  4. 4.

    For high interscalene block with a nerve stimulator, the most reliable motor endpoint is:

    1. (a)

      Shoulder abduction

    2. (b)

      Scapular elevation and internal rotation

    3. (c)

      Lateral rotation of the neck

    4. (d)

      Arm flexion and pronation

  5. 5.

    This nerve provides sensory innervation of the larynx above the vocal cords:

    1. (a)

      Superior laryngeal nerve

    2. (b)

      Glossopharyngeal nerve

    3. (c)

      Recurrent laryngeal nerve

    4. (d)

      External branch of the superior laryngeal nerve

  6. 6.

    Which complication is specific to the retrobulbar block?

    1. (a)

      Globe perforation

    2. (b)

      Oculocardiac reflex

    3. (c)

      Subarachnoid injection

    4. (d)

      Trauma to adjacent structures

  7. 7.

    While performing a scalp block, which of these specific branches does not need aspiration prior to injection?

    1. (a)

      Supratrochlear

    2. (b)

      Supraorbital

    3. (c)

      Auriculotemporal

    4. (d)

      Greater occipital

  8. 8.

    During a retrobulbar block, the patient’s gaze should be ideally oriented:

    1. (a)

      Superonasally

    2. (b)

      Inferonasally

    3. (c)

      Superolaterally

    4. (d)

      Inferolaterally

Answers

  1. 1.

    d

  2. 2.

    a

  3. 3.

    c

  4. 4.

    b

  5. 5.

    a

  6. 6.

    c

  7. 7.

    a

  8. 8.

    b

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Cite this chapter

Persaud, D., Garneau, S. (2018). Head and Neck Regional Anesthesia. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_16

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

  • eBook Packages: MedicineMedicine (R0)

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