The cervical plexus, an anatomical target for the treatment of chronic postoperative pain

The cervical plexus, an anatomical target for the treatment of chronic postoperative pain

Doctors Jorge Orduña and Carlos Tornero, members of the INCLIVA Anesthesia Research group, publish a case of improvement in pain parameters in the Journal of Pain Research.

Chronic pain in patients with head and neck cancer after surgery is generally associated with tumor growth, or with anatomic changes that may occur during perioperative surgery or after radiation therapy. Tumor growth can cause mucosal ulcers, inflammation, edema, infection, and also entrapment of neural structures causing chronic pain that is difficult to resolve.

«This case has demonstrated that the cervical plexus is a possible target for intervention techniques for chronic postoperative pain,» says Dr. Carlos Tornero, co-author of the study.

The authors report a case of improvement in pain parameters, this is a 45-year-old man with severe postoperative pain after undergoing partial surgery: glosectomy and functional dissection of the neck for squamous cell carcinoma of the tongue. The patient was treated pharmacologically for several years with minimal results. After a successful superficial blockage of the cervical plexus under ultrasound vision, the patient improved in the following years of medical visits.

The use of the cervical plexus blocking technique under ultrasound allows direct and dynamic results to be obtained, thanks to the visualization of the structures of the nerves of the neck. It is also possible to observe post-surgical changes such as neuromas, fibrosis adhesions, and direct vision when different therapies are performed, such as the release of adhesions, the deposit of anti-inflammatories, or the application of different types of radiofrequency ablation. The plexus of the cervical region is basic for sensory innervation, becoming an important target for interventional pain treatments. However, due to its location, it is a difficult anatomical area with risk of complications, according to the authors of the study.

Cervical plexus as anatomical target for the treatment of postoperative cervical neuropathic pain. Orduña Valls J, Soto E, Ferrandis Martínez M, Nebreda C, Tornero Tornero C. J Pain Research 2019;12: 1217-21.