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<br /> Ultrasound-guided cervical<br /> sympathetic block<br /> Philips tutorial<br /> Samer Narouze, MD, MSc, DABPM, FIPP<br /> Clinical Professor of Anesthesiology and Pain Medicine, OUCOM<br /> Clinical Professor of Neurological Surgery, OSU<br /> Associate Professor of Surgery, NEOUCOM<br /> Chairman, Center for Pain Medicine<br /> Summa Western Reserve Hospital, Cuyahoga Falls, OH<br /> Table of contents<br /> Ultrasound-guided cervical<br /> sympathetic block<br /> 1 Introduction .......................................................................................................................................... 3<br /> 2 Anatomy................................................................................................................................................... 4<br /> 3 Indications .............................................................................................................................................. 5<br /> 4 Ultrasound<a title="Cervical Block Tutorial page 1" href="http://viewer.zmags.com/publication/78a458a3?page=1"> Ultrasound-guided cervical sympathetic block Phil</a> <a title="Cervical Block Tutorial page 2" href="http://viewer.zmags.com/publication/78a458a3?page=2"> Table of contents Ultrasound-guided cervical sy</a> <a title="Cervical Block Tutorial page 3" href="http://viewer.zmags.com/publication/78a458a3?page=3"> 1 Introduction Cervical sympathetic blocks are </a> <a title="Cervical Block Tutorial page 4" href="http://viewer.zmags.com/publication/78a458a3?page=4"> 2 Anatomy The cervical sympathetic chain is com</a> <a title="Cervical Block Tutorial page 5" href="http://viewer.zmags.com/publication/78a458a3?page=5"> 3 Indications Diagnostic Stellate ganglion bloc</a> <a title="Cervical Block Tutorial page 6" href="http://viewer.zmags.com/publication/78a458a3?page=6"> 3 Indications Most common indications Neuropath</a> <a title="Cervical Block Tutorial page 7" href="http://viewer.zmags.com/publication/78a458a3?page=7"> Limitations of the current blind or fluoroscopy –</a> <a title="Cervical Block Tutorial page 8" href="http://viewer.zmags.com/publication/78a458a3?page=8"> 3 Indications Although computerized tomography </a> <a title="Cervical Block Tutorial page 9" href="http://viewer.zmags.com/publication/78a458a3?page=9"> Figure 2 AP view showing the “ideal” spread of th</a> <a title="Cervical Block Tutorial page 10" href="http://viewer.zmags.com/publication/78a458a3?page=10"> 4 Ultrasound-guided cervical sympathetic blo</a> <a title="Cervical Block Tutorial page 11" href="http://viewer.zmags.com/publication/78a458a3?page=11"> On the other hand, if injection is made anterior </a> <a title="Cervical Block Tutorial page 12" href="http://viewer.zmags.com/publication/78a458a3?page=12"> 4 Ultrasound-guided cervical sympathetic blo</a> <a title="Cervical Block Tutorial page 13" href="http://viewer.zmags.com/publication/78a458a3?page=13"> Figure 4 Short axis sonogram at C7 as indicated b</a> <a title="Cervical Block Tutorial page 14" href="http://viewer.zmags.com/publication/78a458a3?page=14"> 4 Ultrasound-guided cervical sympathetic blo</a> <a title="Cervical Block Tutorial page 15" href="http://viewer.zmags.com/publication/78a458a3?page=15"> Figure 5 Short axis sonogram of the anterior neck</a> <a title="Cervical Block Tutorial page 16" href="http://viewer.zmags.com/publication/78a458a3?page=16"> 4 Ultrasound-guided cervical sympathetic blo</a> <a title="Cervical Block Tutorial page 17" href="http://viewer.zmags.com/publication/78a458a3?page=17"> 5 Technique for ultrasound- guided injection</a> <a title="Cervical Block Tutorial page 18" href="http://viewer.zmags.com/publication/78a458a3?page=18"> 5 Technique for ultrasound- guided injection</a> <a title="Cervical Block Tutorial page 19" href="http://viewer.zmags.com/publication/78a458a3?page=19"> The transducer is then moved slowly cephalad unti</a> <a title="Cervical Block Tutorial page 20" href="http://viewer.zmags.com/publication/78a458a3?page=20"> 5 Technique for ultrasound- guided injection</a> <a title="Cervical Block Tutorial page 21" href="http://viewer.zmags.com/publication/78a458a3?page=21"> At this point the C6 and C7 levels are identified</a> <a title="Cervical Block Tutorial page 22" href="http://viewer.zmags.com/publication/78a458a3?page=22"> 5 Technique for ultrasound- guided injection</a> <a title="Cervical Block Tutorial page 23" href="http://viewer.zmags.com/publication/78a458a3?page=23"> To avoid puncturing vital structures, identify an</a> <a title="Cervical Block Tutorial page 24" href="http://viewer.zmags.com/publication/78a458a3?page=24"> 5 Technique for ultrasound- guided injection</a> <a title="Cervical Block Tutorial page 25" href="http://viewer.zmags.com/publication/78a458a3?page=25"> Figure 9b Long axis sonogram showing the longus c</a> <a title="Cervical Block Tutorial page 26" href="http://viewer.zmags.com/publication/78a458a3?page=26"> 5 Technique for ultrasound- guided injection</a> <a title="Cervical Block Tutorial page 27" href="http://viewer.zmags.com/publication/78a458a3?page=27"> 6 Complications In general SGB has a low incid</a> <a title="Cervical Block Tutorial page 28" href="http://viewer.zmags.com/publication/78a458a3?page=28"> 6 Complications Minor complications SGB is also</a> <a title="Cervical Block Tutorial page 29" href="http://viewer.zmags.com/publication/78a458a3?page=29"> 7 Key points • Cervical sympathetic blocks prov</a> <a title="Cervical Block Tutorial page 30" href="http://viewer.zmags.com/publication/78a458a3?page=30"> 8 References 1. Narouze SN (Ed.). Atlas of ultr</a> <a title="Cervical Block Tutorial page 31" href="http://viewer.zmags.com/publication/78a458a3?page=31"> 22. Slappendel F, Thijssen H, Crul BJ, Merx JL: </a> <a title="Cervical Block Tutorial page 32" href="http://viewer.zmags.com/publication/78a458a3?page=32"> Additional resources Additional resources relat</a> <a title="Cervical Block Tutorial page 33" href="http://viewer.zmags.com/publication/78a458a3?page=33"> Philips Healthcare is part of Royal Philips Elect</a>