Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

Abstract

BackgroundSurgical-site, multimodal drug injection has recently evolved to be a safe and useful method for multimodal pain management even in patients with musculoskeletal trauma.MethodsFifty consecutive patients who underwent plating for mid-shaft and distal clavicular fractures were included in the study. To evaluate whether surgical-site injections (SIs) have pain management benefits, the patients were divided into two groups (SI and no-SI groups). The injection was administered between the deep and superficial tissues prior to wound closure. The mixture of anesthetics consisted of epinephrine hydrochloride (HCL), morphine sulfate, ropivacaine HCL, and normal saline. The visual analogue scale (VAS) pain scores were measured at 6-hour intervals until postoperative hour (POH) 72; stress biomarkers (dehydroepiandrosterone sulfate [DHEA-S], insulin, and fibrinogen) were measured preoperatively and at POH 24, 48, and 72. In patients who wanted further pain control or had a VAS pain score of 7 points until POH 72, 75 mg of intravenous tramadol was administered, and the intravenous tramadol requirements were also recorded. Other medications were not used for pain management.ResultsThe SI group showed significantly lower VAS pain scores until POH 24, except for POH 18. Tramadol requirement was significantly lower in the SI group until POH 24, except for POH 12 and 18. The mean DHEA-S level significantly decreased in the no-SI group (74.2 ± 47.0 µg/dL) at POH 72 compared to that in the SI group (110.1 ± 87.1 µg/dL; p = 0.046). There was no significant difference in the insulin and fibrinogen levels between the groups. The correlation values between all the biomarkers and VAS pain scores were not significantly different between the two groups (p > 0.05).ConclusionsAfter internal fixation of the clavicular fracture, the surgical-site, multimodal drug injection effectively relieved pain on the day of the surgery without any complications. Therefore, we believe that SI is a safe and effective method for pain management after internal fixation of a clavicular fracture.

Posterior Displacement and Angulation of Displaced Lateral Clavicle Fractures: A 3-Dimensional Analysis

“…Lateral clavicle fractures represent 10% to 30% of all clavicle fractures. 1 , 9 , 13 , 14 Although relatively uncommon compared with shaft fractures, lateral clavicle fractures still represent a diagnostic and therapeutic challenge for shoulder surgeons. 3 Delayed union or nonunion after nonoperative treatment for lateral clavicle fractures is common, especially when the fracture is displaced.…”

Clavicular Fractures in the Adolescent

“…This may help to explain why some patients experience more pain than others. Adult patients with clavicular fracture have reported pain scores in the 6 to 7 range acutely and >5 at even 4 weeks after the injury [44][45][46] . Additionally, primary fixation of a clavicular fracture generally provides earlier pain relief 1 .…”

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

“…Fractures of the clavicle are associated with significant pre- and post-operative pain [ 6 ]. Although general anesthesia (GA) is commonly employed, clavicle fixation surgery performed under regional anesthesia (RA) with or without sedation is feasible and has been previously reported [ 7 , 8 ].…”

“…Although general anesthesia (GA) is commonly employed, clavicle fixation surgery performed under regional anesthesia (RA) with or without sedation is feasible and has been previously reported [ 7 , 8 ]. Multimodal analgesia utilizing surgical site infiltration, and different permutations of peripheral nerve blocks targeting the cervical plexus, brachial plexus, or their branches, have been described in the literature [ 6 , 9 , 10 ]. Given the breadth of techniques reported in the literature, stronger evidence to determine the most appropriate regional technique for emergency department and perioperative (surgical fixation) settings is required [ 11 ].…”