Purpose/Objective On the basis of our cryosectional studies using the visual human project dataset and additionally data of a MRI study on a healthy volunteer, we describe the basic understanding for save procedures for performing the intermediate cervical plexus block. Beyond the experience of more than 1000 carotid endarterectomies under regional anesthesia, we further explored the feasibility of the block for hemithyreoidectomies and parathyreoidectomies.

Materials and methods Cadaver axial cross-sectional images were analysed within 1 mm slices. the track of the anterior nerve roots of the cervical nerves from the spinal cord to the Erb´s Point was followed. the results of the cross sectional method were compared with special T2-weighted MRI sequences on a volunteer.

Results The anterior cervical nerve roots emerge laterally to longus colli and longus capitis muscles and medially to the medial scalene and levator scapulae muscles. the spinal nerves of C2-C4 move in a well-defined layer between the superficial and deep cervical fascia, we call the ‘cervical nerves pathway’. More than 1000 carotid endarterectomies were feasible with a rare number of adverse effects. Even x hemithyreoidectomies and parathyreoidectomies were successfully performed under the same regional anesthesia technique.

Conclusions An injection in the ‘cervical nerves pathway’ at the level of C4 leads to a reliable ‘C2-C4 Compartment Block’ for carotid endarterectomy with rarely complications. Even hemithyreoidectomies and parathyreoidectomies are easily feasible, as shown on a series of cases with success in all cases and with no serious adverse effects.