Low-Volume Local Anesthetics for C5 and Supraclavicular Nerve Blocks for Mid and Lateral Clavicle Surgery: A Case Series

Abstract

After institutional ethics committee approval and informed consent, 20 patients with clavicle fractures were recruited. An ultrasound-guided C5 root block was performed by injecting 3 mL of 0.5% bupivacaine with a subsequent ultrasound-guided supraclavicular nerve (SCN) block with 3 mL of 0.5% bupivacaine. A combination of low-volume C5 root block and SCN block provided reliable awake anesthesia and postoperative analgesia in patients with fractured clavicles. This technique can avoid a general anesthesia for fractures of the mid and lateral clavicle. Further studies should focus on the optimal volume of local anesthetics required for the success of this technique.

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

“…Following a thorough review of the titles, abstracts, full-text, and reference lists, we included and extracted data from a total of 44 studies and/or reports containing patient data, spanning a total of 3161 patients with clavicular fractures who received some form of regional anesthesia and analgesia. We excluded one retracted article and its retraction note from the final list of 44 studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 5 RCTs, 5 prospective observational studies, 5 retrospective observational studies, and 29 case reports/case series included in this scoping review ( Figure 1 and Table 2 ).…”

Selective blockade of supraclavicular nerves and upper trunk of brachial plexus “The SCUT block” towards a site-specific regional anaesthesia strategy for clavicle surgeries - A descriptive study

“…Following 3-ml injection for the SCN, we observed sensory blockade similar to that described in previous studies. [ 4 9 ] However, 20% of patients had an additional involvement of the transverse cervical branch [ Table 1 , which we attribute to a medial and proximal spread of LA within the same fascial plane. UT block with 5-ml revealed CCB in territories of suprascapular, axillary, and musculocutaneous nerves in all patients, grade 1 sensory block in radial nerve territory of the forearm in 20% of patients and sparing of median and ulnar nerves in all patients.…”

“…As the minimum effective LA volume that achieves these objectives has not been defined, we chose 3 ml for the SCN block and 5 ml for UT block from published studies and the authors’ experience. [ 4 7 ]…”

“…[ 11 12 13 ] One of the authors recently explored the selective C5 nerve root injection with SCN block as a sole anaesthetic technique for clavicle surgery in 20 patients. [ 4 ] Even though the strategy was more site-specific with the sparing of musculocutaneous nerve in 100% of the patients and axillary nerve in 60% patients, there was inadequate blockade in four out of 20 patients (i.e. 20% failure) especially at the lateral end of clavicle.…”

“…Selective C5 root block with SCN block and the clavipectoral fascial plane block have been described as possible strategies for clavicle surgery. [ 4 5 6 ] With the introduction of high resolution ultrasound imaging and better understanding of sonoanatomy, currently the SCN and individual components of the BP namely the ventral rami and trunks can be identified for selective blockade with low volumes. [ 5 7 8 ] As the nerve to subclavius, suprascapular nerve and two thirds of the fascicles to long thoracic nerve arise from the upper trunk (UT) of BP, we designed this study to analyse and describe the dynamics of selectively blocking the SCN along with the UT of the BP (SCUT BLOCK), towards a selective, site-specific regional anaesthesia strategy for clavicle surgery.…”