Tips for a Cervical Sympathetic Block

A cervical sympathetic block is performed to manage patients with various pain conditions, including complex regional pain syndrome and peripheral vascular disease.

We wanted to share these 3 tips to successfully perform a cervical sympathetic block:

1. Place the transducer at the C6 level to allow cross-sectional visualization of the transverse process and anterior tubercle of C6, longus colli muscle and prevertebral fascia, and carotid artery and thyroid gland.
2. A prescan is important in planning the needle path as the presence of the esophagus and inferior thyroidal artery may obviate the needle path between the carotid artery and trachea.
3. Direct the needle to the prevertebral fascia between the carotid artery and the tip of the C6 anterior tubercle to inject 5 mL of local anesthetic.

Sonoanatomy

Reverse Ultrasound Anatomy

Comparison of sonoanatomy and reverse ultrasound anatomy for a cervical sympathetic block.

Download the US Pain App HERE to read other tips on managing acute and chronic pain and to access the complete guide to ultrasound-guided chronic pain blocks.