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Cervical plexus block spread — FRCA Final MCQ

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HardRegional AnaesthesiaCervical plexus block spreadFRCA Final

A 70-year-old man undergoing awake carotid endarterectomy has a superficial cervical plexus block. Shortly after incremental injection he develops hoarseness, ipsilateral ptosis and mild dyspnoea, but oxygen saturation remains 96% and haemodynamics are stable. What is the most likely cause of the complication?

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Correct answer: C — Local anaesthetic spread to cervical sympathetic and recurrent laryngeal structures

Horner's syndrome and hoarseness after cervical plexus block reflect local anaesthetic spread to nearby autonomic and laryngeal nerve structures. High spinal would cause more profound hypotension, bilateral weakness and respiratory compromise. Stroke is a critical differential during carotid surgery but does not explain the ipsilateral sympathetic signs immediately after injection. Careful incremental injection and aspiration reduce, but do not remove, the risk of spread.

Reference: RA-UK regional anaesthesia guidance; Vascular Anaesthesia Society guidance