Comparison of Intermediate Vs Subcutaneous Superficial Cervical Plexus Block for Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Study.

Intermediate Vs Subcutaneous Superficial Cervical Plexus Block

Abstract

Background: Superficial cervical plexus has been used successfully for postoperative analgesia following anterior cervical discectomy and fusion (ACDF) surgery. It is not known if superficial and intermediate cervical blocks are equally effective, although anatomical evidence suggests that the latter might provide superior quality of analgesia. The aim of our study was to compare the effect of intermediate cervical plexus block (ICPB) vs superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing ACDF surgery. Subjects and Methods: Forty-nine patients were randomised to receive either bilateral ICPB or bilateral SCPB in patients undergoing elective single- or two-level ACDF surgery. The primary outcome measure was the quality of recovery at 24 hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for intra- and postoperative opioid consumption. Groups were compared using Students t test, Mann-Whitney U test or Chi-square test for different type of data. A p-value of <0.05 was considered statistically significant. Results: The mean (SD) aggregated global QoR-40 scores at 24 hr were significantly greater in the ICPB group, indicating good quality of recovery compared with the SCPB (186 9 vs 173 12, respectively; P = 0.001). Intra- and postoperative opioid consumption was significantly higher in SCPB group. No major block related complications were noticed during the study. Conclusion: We showed that compared to SCPB, ICPB provides better analgesia in patients undergoing single- or two-level ACDF, thereby improving the early quality of recovery. We strongly believe the existence of investing layer of cervical fascia of neck.