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The superficial cervical plexus supplies sensation to the neck and shoulder. It is formed from the anterior rami of C2-C4 nerve roots. The branches of the plexus pierce the cervical fascia to emerge posterior to the mid-point of sternocleidomastoid muscle.

The sensory branches of the superficial cervical plexus are the lesser occipital, greater auricular, transverse cervical and supraclavicular nerves.

Patient supine, head turned to the contralateral side. Transducer initially applied at the level of the cricoid cartilage in the axial, oblique plane. Similar to the positioning for an interscalene block.

From the level of the cricoid cartilage, identify the interscalene groove and brachial plexus. Scan cranially and observe the C6 and then C5 nerve roots move deep towards their respective transverse processes (see interscalene chapter for images). At the level of the C5 transverse process, the superficial cervical plexus can be seen superficially as a line of hyperechoic beads in the fascial plane deep to the SCM muscle.

Figure 2: Ultrasound image of a) superficial cervical plexus b) annotated image (CA=carotid artery; IJV=internal jugular vein; C5-TP=C5 transverse process; C5=C5 nerve root; SCP=super cial cervical plexus; SCM=sternocleidomastoid muscle).

Small hyperechoic beads superior and super cial to C5 transverse process, deep to sternocleidomastoid posterior border. May be difficult to visualise the individual nerves.

Insert the needle posterior to the transducer using an in-plane approach (from posterior
to anterior). Injection of local anaesthetic should fill the fascial plane deep to the sternocleidomastoid muscle and be seen to spread freely towards the internal jugular vein.

1. It can often be quite tough to advance the needle in the fascial plane deep to the sternocleidomastoid muscle. Gentle pressure and hydrodissection may help.

2. When performing the block for carotid surgery the needle can be advanced slowly, under direct vision, towards the jugular vein and carotid artery to deposit local anaesthetic adjacent to the carotid sheath. This is often referred to as an intermediate cervical plexus block.