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the intermediate cervical plexus block consists of injecting local anesthetic deep to the investing fascia and superficial to the pre-vertebral fascia we want to be at the C4 level when we perform this block as we scan cephalot at the neck we can see the shadow of each transverse process come into view it sort of looks like a teacup we see each nerve root dive into its respective transverse process when we arrive at the C4 level notice that the Carotid artery bifurcates we can therefore use the bifurcation of the Carotid artery to approximate the C4 level at the C4 level we see the C4 transfers process sternocleidomastoid muscle and levator scapulae muscle posterior to the sternocleidomastoid muscle we have the investing fascia and superficial to the levator scapula muscle we have the pre-vertebral fascia our aim with the intermediate approach is to place local anesthetic in between these two fascial layers this will result in analgesia of the anterior lateral neck as well as the anter
