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Stabilize the neck position, and identify the sternocleidomastoid muscle.
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If not using the ultrasound, always feel for the infiltration with the other hand to avoid injecting the local anesthetic in any vascular structure.
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Infiltrate along the posterior border of the sternocleidomastoid muscle superior and inferior to the point of needle entry.
Position
Place the patient in the supine position without a pillow. The head is turned to the opposite side of the one being blocked ( Fig. 45.1 ).
Anatomy and technique
The superficial cervical plexus provides cutaneous innervation to the ventral rami of C1 to C4 ( Fig. 45.2 ). It includes the lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves ( Fig. 45.3 ). At the midpoint on the posterior border of the sternocleidomastoid muscle is the point of needle entry. The needle is inserted, and local anesthetic is injected behind and along the posterior border of the clavicular head of the sternocleidomastoid muscle.
