Opioid-Sparing Pediatric Anesthesia via Ultrasound-Guided Superficial Cervical Plexus Block with Perineural Dexamethasone in Recurrent Cervical Lymphangioma Excision: An Observational Analytic Case Study

Abstract

Background. Recurrent cervical lymphatic malformation excision in children presents challenges related to scarred tissue planes, airway proximity, and opioid-related respiratory effects. Pediatric evidence for superficial cervical plexus block (SCPB) in this setting is limited.

Objective. To describe perioperative analgesia, hemodynamic trajectories, and recovery after ultrasound-guided SCPB during recurrent cervical lymphangioma excision.

Methods. A 9-year-old girl weighing 24 kg underwent re-excision under balanced general anesthesia. A unilateral ultrasound-guided SCPB used 8.0 mL ropivacaine 0.2% (16 mg; 0.67 mg/kg) with perineural dexamethasone 5.0 mg (approximately 0.21 mg/kg). Hemodynamics, oxygenation, and FLACC pain scores were recorded from baseline through postoperative day one. The authors also applied adapted causality frameworks.

Results. Surgery lasted 120 minutes. Recorded mean arterial pressure ranged from 70.00 to 76.67 mmHg and heart rate from 92 to 105 beats/min. No supplemental opioids were administered after induction fentanyl (1.5 µg/kg). Awake extubation occurred within eight minutes. FLACC scores were 0–1; no PACU rescue analgesia or postoperative nausea or vomiting was reported. Oral fluids were tolerated after two hours, and discharge occurred on postoperative day one. The reported adapted Naranjo score was +8. Follow-up at seven and thirty days recorded uneventful healing without neuropathic pain.

Conclusion. In this patient, SCPB with ropivacaine and dexamethasone accompanied an opioid-sparing perioperative course. A single uncontrolled observation cannot establish comparative efficacy, causation, or general safety.