Ultrasound-Guided Intermediate Cervical Plexus Block for Postoperative Analgesia in Vagus Nerve Stimulation Surgery

Postoperative pain following vagus nerve stimulation (VNS) implantation surgeryoriginates from both cervical and infraclavicular surgical incisions. Although opioidanalgesics are commonly used for postoperative pain control, minimizing opioid exposureis particularly desirable in patients with drug‐resistant epilepsy because opioid‐relatedadverse effects may delay recovery and potentially influence neurological assessment.The intermediate cervical plexus block (ICB) is an ultrasound‐guided regional anesthesiatechnique that provides sensory blockade of the superficial branches of the cervicalplexus while allowing accurate deposition of local anesthetic between the investing andprevertebral layers of the deep cervical fascia. Previous studies have demonstrated theeffectiveness of cervical plexus blocks in various cervical surgical procedures; however,evidence regarding their use during VNS implantation surgery remains limited.This prospective, randomized, double‐blind, placebo‐controlled study comparesultrasound‐guided ICB using 10 mL of 0.25% bupivacaine with a placebo injection of 10 mLnormal saline administered after induction of general anesthesia. The primary objectiveis to determine whether ICB reduces postoperative opioid requirements during the first 24hours after surgery. Secondary objectives include evaluation of intraoperativeremifentanil consumption, postoperative pain scores, time to first rescue analgesic,length of hospital stay, and postoperative seizure incidence. The findings are expectedto provide evidence regarding the effectiveness and safety of ultrasound‐guidedintermediate cervical plexus block as part of multimodal analgesia for patientsundergoing VNS implantation surgery.