Ultrasound-Guided Clavipectoral Fascial Plane Block for Surgery Involving the Clavicle: A Case Series

Ultrasound-Guided Clavipectoral Fascial Plane Block as a Stand-Alone Anesthetic Technique for Clavicle Fracture Management: A Case Report

The clavipectoral fascial plane block (CFPB) that has been utilized for clavicle fracture surgeries and pain management is an emerging anesthetic technique. It has been previously used for postoperative pain management, but it can also be used as a stand-alone anesthetic technique for clavicle fracture management. Here we describe a case of a 20-year-old male who underwent open reduction and internal fixation (ORIF) with plating for a mid-shaft clavicular fracture under a CFPB as a sole anesthetic.

Clavipectoral Fascia Plane Block Combined With Superficial Cervical Plexus Block for the Removal of Osteosynthesis Material From Clavicle Fracture

Clavipectoral fascial plane block combined with superficial cervical plexus block has been used as an anesthetic and analgesic technique in mid-clavicle fracture surgeries. The authors describe two cases in which patients underwent extraction of osteosynthesis material from the clavicle, using clavipectoral fascial plane block combined with superficial cervical plexus block as an anesthetic and analgesic technique in the postoperative period. The mentioned block presented itself as an easy-to-perform technique, apparently safe and effective, allowing to obtain satisfactory results.

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

Objective. Clavicle fractures are common injuries potentially associated with significant perioperative pain. However, this region’s complex sensory innervation poses a challenge for regional anesthetic or analgesic (RA) techniques. We conducted this scoping review to summarize the current literature, particularly with regards to motor-sparing techniques. Methods. A scoping review was carried out in accordance with the Joanna Briggs Institute’s framework. All articles describing the use of RA for clavicle fractures or surgery were included. PubMed^®, Ovid MEDLINE^®, EMBASE^®, Scopus^®, CINAHL^®, and the Cochrane database were searched without language restrictions. Results. Database searches identified 845 articles, 44 of which were included in this review, with a combined patient total of 3161. We included all peer-reviewed publications containing clinical data and summarized the findings. Conclusions. Current evidence of RA techniques in clavicle surgery is heterogeneous, with different approaches used to overcome the overlapping sensory innervation. The literature largely comprises case reports/series, with several randomized controlled trials. Intermediate cervical plexus block is the regional technique of choice for clavicle surgery, and can provide reliable surgical anesthesia when combined with an interscalene block. Cervical plexus block can provide motor-sparing analgesia following clavicle surgery. Promising alternatives include the clavipectoral block, which is a novel motor-sparing regional technique. Further studies are required to determine the efficacy and safety of various techniques.

Ultrasound-Guided Clavipectoral Block for Postoperative Analgesia of Clavicular Surgery: A Prospective Randomized Trial

Background

Clavicular fractures are commonly encountered in daily practice, and most cases are operated under general surgery. Until now, there has been a debate about the best approach to manage pain in such cases.

Objectives

We aimed to evaluate whether ultrasound-guided clavipectoral block [clavipectoral fascial plane block (CPB)] would be safe and effective in cases with clavicular fractures.

Methods

This prospective randomized study included a total of 40 patients with clavicular fractures; they were divided into 2 groups. Group 1 included 20 cases who underwent CPB, and group 2 included 20 cases who underwent placebo block. Pain score, duration of analgesia, total analgesic consumption, and procedure-related complications were noted and recorded.

Results

Despite the comparable demographic data between the 2 groups, pain scores were significantly lower in group 1 than in group 2, starting from postanesthesia care unit (PACU) admission until 12 hours after the operation. Group 1 showed a significant reduction in 24-hour opioid consumption and significant prolongation of the duration of analgesia compared to the placebo. Patient satisfaction was significantly better in group 1 than in group 2. No block-related adverse events were recorded.

Conclusions

CPB is a safe and effective regional technique that should be used for pain management after clavicular fixation surgery.

Clavipectoral plane block as a sole anesthetic technique for clavicle surgery - A case report

Background

The clavipectoral fascial plane block was introduced by Dr. Luis Valdes in a symposium at the 2017 European Society of Regional Anesthesia and Pain Therapy Congress.

Case

Clavipectoral plane block (CPB) with intravenous sedation provided surgical anesthesia and analgesia in a 39-year-old male patient with a right midshaft clavicle fracture. This in-plane technique was used to deposit 30 ml of a local anesthesia mixture between the clavipectoral fascia and periosteum on both the medial and lateral sides of the fracture line.

Conclusions

Excellent anesthesia and analgesia for up to 16 h post-block were provided by CPB during the clavicle surgery.

Awake Single-Stage Bilateral Clavicle Surgeries Under Bilateral Clavipectoral Fascial Plane Blocks: A Case Report and Review of Literature

The clavicle is a frequently fractured bone with an infrequent bilateral occurrence. Regional anesthesia (RA) for clavicle surgeries is always challenging due to its complex innervation arising from the two plexuses (cervical and brachial). Various RA techniques described for clavicle surgeries include plexus blocks, fascial plane blocks, and truncal blocks. Plexus blocks are associated with undesirable effects, such as phrenic nerve blockade and paralysis of the entire upper limb, limiting their application for bilateral regional clavicle surgeries. The clavipectoral fascial plane block (CPB) is a novel, procedure-specific, phrenic-sparing, and motor-sparing RA technique that can provide anesthesia or analgesia for clavicle surgeries. The decision to use the CPB and/or other RA techniques may depend on the site of clavicle injury or variations in clavicular innervation. We report a case of single-stage bilateral clavicle surgery successfully managed with a bilateral CPB alone using ultrasound guidance and landmark guidance separately. The patient was kept awake and comfortable throughout the surgery. In conclusion, CPB can be an effective alternate RA technique in avoiding undesired side effects of more proximal techniques such as phrenic nerve involvement and motor blockade of upper limbs. Landmark-guided CPB can be an alternative with equianalgesic efficacy as of ultrasound-guided CPB in resource-poor or emergency settings.