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

Abstract

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.

The effect of clavipectoral fascia plane block or interscalene brachial block on the postoperative analgesia after clavicle surgery: Randomized controlled study

“…The ultrasound-guided approach is more favorable than the landmark-based technique because we can visualize the LA distribution within the right plane, boosting success rate [4,5] . Valdés-Vilches described the clavipectoral fascial plane block (CPB) as a novel as well as safe regional anesthesia approach in 2017 [6] . They reported injecting around ten to fifteen mL of the LA agent utilizing ultrasonographicguidance into the gap between the clavipectoral fascia as well as the clavicle periosteum, in both the fracture site medial along with lateral parts [7,8] .…”

Continuous Interscalene Nerve Block for a Midshaft Clavicle Fracture: An Opioid-Sparing Postoperative Analgesic Strategy

“…Clavicle fractures represent approximately 2.6% of reported fractures and 44% of fractures involving the shoulder girdle. Midshaft clavicle fractures are the most common, representing approximately 75% of clavicle fractures [ 1 ]. When clavicle fractures require open reduction and internal fixation (ORIF), a general anesthetic (GA) approach is typically chosen; however, clavicle fixation with only regional anesthesia has been reported and appears to be a feasible option for some patients.…”

“…Due to the complex and variable innervation of the clavicle [ 2 ], regional anesthetic techniques for clavicle fixation are difficult to achieve with one block. As a result, several peripheral nerve blocks and block combinations have been trialed [ 1 ], and much debate still exists regarding the optimal approach.…”

“…Most of the research into regional anesthesia for clavicle fractures, with and without GA, describes single-shot blocks for perioperative anesthesia. In general, postoperative pain data are limited to the day of surgery [ 1 ]. There are limited data regarding the management of clavicle ORIF pain with perineural catheter placement.…”

Awake clavipectoral facial plane block for clavicle surgeries: A case series

“…CPB does not cover surgeries involving the medial end of the clavicle; hence, the additional supraclavicular block must be supplemented in such cases. [ 3 7 ] Similarly, the lateral end of the clavicle fracture needs an ultrasound-guided C5 nerve root block with a very small volume of local anaesthetic agent. T Sivashanmugam et al .…”