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Abstract
Background and Aims The complex innervation of the clavicle makes it challenging to achieve a complete nerve block for clavicular surgery; the medial part being most arduous. We present a case of a successful clavicular repair in a high-risk patient, performed entirely in peripheral nerve blocks. A 54-year old male, active smoker, involved in a motorcycle accident 7 days earlier, suffered a fractured clavicle and scapula, flail chest with costa 2–9 fractures, haemo-pneumothorax as well as lung contusions/lacerations – all to his right side. The clavicle was spirally fractured, extending from and through the shaft to medial part. Injuries were initially treated with drainage and additional oxygen therapy. The chest drain was inadvertently removed a few days prior to surgery, leaving minimal pneumothorax. Considering the patient’s condition and medical background, we aimed to avoid mechanical ventilation as well as preserving the function of the diaphragm throughout the perioperative period. To achieve set goals, we chose a clavipectoral fascia block combined with a block of the supraclavicular nerve.
Methods We performed an ultrasound-guided clavipectoral fascia block, using 30 ml Ropivacaine 5mg/ml. A supplementary superficial cervical plexus block with 8 ml Ropivacaine 5mg/ml was performed due to unreliably detecting the supraclavicular nerve.
Results No additional intraoperative analgesia was required. Full diaphragmic function was asserted by ultrasound post-surgery, and post-operative care was uneventful with sufficient analgesia.
Conclusions A clavipectoral fascia block may be a good alternative to general anesthesia and other regional anesthesia techniques for clavicular surgery in high-risk patients.