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Background and Aims General anesthesia (GA) has been the anesthetic choice for clavicle surgery (CS) since regional techniques can be particularly challenging. Interscalene brachial plexus block (ISC) combined with superficial cervical plexus block (SCP) has been successfully performed, but not without risks. Recently, the clavipectoral plane block (CPB) was described as an injection of local anesthetic (LA) under the clavipectoral fascia. CPB avoids potential side effects related with ISC such as motor block of the upper limb (UL), phrenic nerve palsy, Horner’s syndrome, vertebral artery injection and total spine anesthesia.
Methods A 48-year-old male, ASA I with complete displaced fracture on the lateral third shaft of the clavicle, was purposed for an open fixation with a plate and screws. The patient had four rib fractures on the ipsilateral side with mild respiratory impairment. An ultrasound guided SCP and CPB (3 injections on the 3 points above the clavicle) were performed, with a total of 40 mL of LA (20 mL ropivacaine 0,5% and 19 mL lidocaine 1,5%), under sedation (1 mg midazolam, 50 ug fentanyl).
Results The patient remained comfortable and stable throughout the surgery, under propofol (4 mg/kg/h).
Conclusions The combination of CPB and SCP is a safe and useful technique for CS. The prevention of phrenic nerve block and pneumothorax remain the two advantages in this case report. Moreover, it allows preservation of motor function of the UL and avoidance of GA. It remains unclear if this block maintains his success profile in case of ruptured clavipectoral fascia.
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