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Point-of-care ultrasound-guided regional anaesthesia: the superficial cervical plexus block for a patient with a clavicle fracture
  1. Sally Graglia1,2,3,
  2. Aaron Kornblith3
  1. 1 Emergency Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
  2. 2 Emergency Medicine, UCSF, San Francisco, California, USA
  3. 3 Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Sally Graglia, Emergency Medicine, San Francisco General Hospital and Trauma Center, San Francisco, CA 94110, USA; sally.graglia{at}

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Case presentation

A right-hand dominant woman aged 46 years with a history of opiate use disorder presents to the ED following a right clavicle injury. While riding to work, the patient fell off her bicycle, landing on her right shoulder. She denies any other injury. On physical examination, she is tearful, cradling her right arm. Her vital signs are normal. Her right clavicle has an obvious deformity and associated bruising without overlying injury or tenting of the skin. She has severely reduced range of motion of the right shoulder due to pain but is neurovascularly intact distally. Plain radiography of her right clavicle (figure 1) revealed a comminuted right clavicular fracture with a coracoclavicular distance of 7 mm. Given her personal history with opioids, the patient declined narcotics but was in severe acute pain. Thus, the ultrasound machine was brought to the bedside in anticipation of ultrasound-guided regional anaesthesia of the superficial cervical plexus.

Figure 1

Right clavicular radiography demonstrating a right comminuted clavicular fracture.

What is a superficial cervical plexus block?

The superficial cervical plexus block (SCPB) targets branches of the cervical plexus, specifically cervical nerve roots C2–C4. These branches emerge from the posterior aspect of the sternocleidomastoid muscle (SCM), about halfway between its origin on the manubrium and medial clavicle and its insertion on the mastoid process posterior to the ipsilateral ear as shown in figure 2.

Figure 2

Cadaveric image of the superficial cervical plexus as it emerges from the posterior aspect of the sternocleidomastoid muscle (SCM) showing specifically the lesser occipital nerve (1), great auricular nerve (2), transverse cervical nerve (3) and supraclavicular nerves (4).

The superficial cervical plexus provides anaesthesia to the skin from the inferior earlobe superiorly, the midline neck anteriorly, the lateral aspect of the trapezius laterally and along the clavicle inferiorly as shown in figure 3. There is no motor innervation by the …

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  • Handling editor Caroline Leech

  • Contributors SG recruited and consented the patient, performed and recorded sonographic imaging and wrote the initial manuscript draft. AK provided multiple revisions and mentorship. SG and AK take responsibility for the manuscript as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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