Bilateral superficial cervical plexus block with or without low-dose intravenous ketamine analgesia: effective, simple, safe, and cheap alternative to conventional general anesthesia for selected neck surgeries

Sandip Mukhopadhyay¹, Mausumi Niyogi², Manotosh Dutta³, Ritam Ray³, Ganesh Chandra Gayen³, Monoj Mukherjee³, Basabdatta Samanta Mukhopadhyay<sup>4

1</sup>Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, ²Department of Anesthesiology, Burdwan Medical College, Burdwan, West Bengal, ³Department of ENT, Burdwan Medical College, Burdwan, West Bengal, ⁴Department of Biochemistry, Christian Medical College, Ludhiana, Punjab, India

Background: General anesthesia is commonly used for surgery in the neck region. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck.
Methods: A total of 136 neck surgery cases were enrolled in this prospective uncontrolled study. All patients were administered ropivacaine 0.5% as a bilateral cervical plexus block. The incision line was infiltrated with lignocaine 1% and adrenaline 1:100,000. For thyroglossal cyst and thyroglossal fistula, an additional 1.5 mL of LA solution was deposited over the hyoid bone on both sides of the midline. Any anesthetic inadequacy was corrected using ketamine 25 mg intravenously and repeated if necessary.
Results: Of 37 patients with thyroglossal cyst, the block was sufficient in 36 patients, and one patient required ketamine. Block was adequate in 23 of 24 patients with thyroglossal fistula, and one patient required ketamine. Among the branchial cyst and branchial fistula cases, six of 16 patients required ketamine supplementation. Of three thyroidectomy patients, one required ketamine supplementation, and one was converted to conventional general anesthesia. For lymph node excision and lymph node biopsy patients, LA block was sufficient in all 31 cases. In the last group, one of 25 patients required ketamine supplementation.
Conclusion: The overall success of bilateral cervical plexus block as a sole method of anesthesia in these selected neck surgeries was 91.9% and with low-dose ketamine supplementation it approached more than 99%. However, cervical plexus block was not a good method of anesthesia for thyroid surgery in this study. For the remainder of cases, bilateral cervical plexus block alone or in conjunction with ketamine appeared to be a cheap, safe, and effective alternative to conventional general anesthesia.

Keywords: superficial cervical plexus block, neck surgery, thyroglossal cyst, thyroglossal fistula, branchial cyst, ketamine