Acute Pain Management Protocol for Neck Procedures

The neck holds a robust nerve supply that lies under identifiable anatomic landmarks in close proximity to vital vascular structures. This presents unique opportunities and challenges to the regional anesthesiologist. Neck regional anesthesia is often administered after induction of general anesthesia, but can also be used as a primary technique or an adjunct during awake intubation. Communication with surgeons remains essential, as some nerve blocks are contraindicated for specific neck pathology or neuromonitoring techniques. In the following review, we will discuss neck surgery cases that would be appropriate for a superficial cervical plexus block and how regional anesthesia can act as a useful tool to prevent postoperative nausea and vomiting. We will also discuss the role of glossopharyngeal, superior laryngeal, and recurrent laryngeal nerve blocks in facilitating a smooth awake intubation and post-radiation neck changes. We will then examine the role of interscalene blocks in a trauma case, closing with a discussion on local anesthetic systemic toxicity.