Clavipectoral fascia plane block spread: an anatomical study

Clavipectoral fascia plane block in midshaft clavicle fractures: A cadaveric study

STUDY OBJECTIVE

The objective of this anatomical study was to investigate the distribution of a solution administered using the Clavipectoral Fascia Plane Block (CPB) technique in a series of cadaveric models with midshaft clavicular fractures. The study aimed to address the knowledge gap regarding the impact of clavicular fractures on the distribution pattern of the CPB-administered solution.

DESIGN

Observational cadaveric study.

SETTING

The research was conducted in the laboratory setting of the University of Barcelona, adhering to the institution's ethical guidelines and standards.

PATIENTS

Five unembalmed human cadavers were used, generating ten clavicle samples.

INTERVENTIONS

A postmortem fracture was induced in the middle third of the clavicle using a blunt-edged hammer, simulating a midshaft clavicular fracture.

MEASUREMENTS

Anatomical dissection was performed in three layers: the superficial muscle plane, deep muscle plane, and clavicular periosteum plane. Dye staining with methylene blue was utilized to assess the distribution pattern.

MAIN RESULTS

In the superficial muscular plane, methylene blue was observed in the deltoid (100%), pectoralis major (100%), sternocleidomastoid (SCM) (70%), and trapezius muscles (100%). Conversely, the deep muscular plane, including the subclavius muscle, pectoralis minor, and Clavipectoral Fascia (CPF), exhibited no staining. At the clavicular periosteum plane, methylene blue distributed predominantly to the antero-superior region (57.3%), with a minimal impact on the postero-inferior area (6.5%).

CONCLUSIONS

The study reveals that the presence of a midshaft clavicular fracture does not significantly alter the diffusion pattern of the CPB-administered solution, maintaining a consistent distribution in both intact and fractured clavicle models.

Ultrasound-Guided Clavipectoral Fascial Plane Block Combined With Intermediate Cervical Plexus Block for Surgery on a Displaced Midshaft Clavicular Fracture in an Adolescent Athlete: A Case Report

Ultrasound-guided clavipectoral fascial plane block (CPB) and intermediate cervical plexus block (ICPB) have been used as novel approaches for clavicular fracture surgery in adults. However, there are few reports of ultrasound-guided CPB combined with ICPB for clavicular surgery in children under 18 years of age. A 16-year-old male baseball player (weight, 57 kg; height, 160 cm) was scheduled to undergo open reduction and internal fixation with superior plate placement for a left-sided displaced midshaft clavicular fracture. We performed ultrasound-guided CPB using 0.25% ropivacaine (10 mL each) on the medial and lateral sides of the clavicle fracture between the periosteum of the clavicle and the clavipectoral fascia and ICPB using 0.25% ropivacaine (5 mL) under general anesthesia. The surgery proceeded smoothly, and the postoperative pain was minimal. In this case, ultrasound-guided CPB combined with ICPB was used effectively and safely to treat clavicular fractures in an adolescent athlete.