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Clavipectoral fascia plane block spread: an anatomical study
  1. Hipolito Labandeyra1,
  2. Cristina Heredia-Carques2,
  3. José Cros Campoy3,
  4. Luis Fernando Váldes-Vilches4,
  5. Alberto Prats-Galino5 and
  6. Xavier Sala-Blanch1,6
  1. 1Human Anatomy and Embryology Unit, Universitat de Barcelona Facultat de Medicina i Ciències de la Salut, Barcelona, Catalunya, Spain
  2. 2Anesthesia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  3. 3Anesthesia, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  4. 4Anesthesia, Hospital Costa del Sol, Marbella, Spain
  5. 5Laboratory of Surgical Nauroanatomy (LSNA); Human Anatomy and Embryology, Universitat de Barcelona Facultat de Medicina i Ciències de la Salut, Barcelona, Catalunya, Spain
  6. 6Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Xavier Sala-Blanch, Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain; xavi.sala.blanch{at}gmail.com

Abstract

Background The clavipectoral fascia plane block (CPB) is a novel anesthetic management strategy proposed by Valdes-Vilches for clavicle fractures. This study aimed to investigate the distribution of the injected solution around the clavicle and the surrounding tissues.

Methods Twelve clavicle samples were acquired from six cadavers. CPB was conducted using a 20 mL solution comprising methylene blue and iodinated contrast agent to improve visibility of the injected substance’s dispersion. Methylene blue spread was assessed through anatomical dissection across distinct planes (subcutaneous, superficial muscular, deep muscular, and periosteal layers of the clavicle) in five cadavers. For the purpose of comparing methylene blue distribution, CT scans were performed on three cadavers.

Results Methylene blue was detected in the medial, intermediate, and lateral supraclavicular nerves, as well as superficial muscles including the deltoid, trapezius, sternocleidomastoid, and pectoralis major. However, no staining was observed in the deep muscle plane, including the subclavius, pectoralis minor, and clavipectoral fascia (CPF). Anterosuperior periosteum exhibited staining in 54% of surface, while only 4% of the posteroinferior surface. CT images displayed contrast staining in anterosuperior periclavicular region, consistent with observations from sagittal sections and anatomical dissections.

Conclusion The CPB effectively distributes the administered solution in the anterosuperior region of the clavicular periosteum, superficial muscular plane, and supraclavicular nerves. However, it does not affect the posteroinferior region of the clavicular periosteum or the deep muscular plane, including the CPF.

  • REGIONAL ANESTHESIA
  • Anesthesia, Conduction
  • Upper Extremity
  • Pain, Postoperative
  • Ultrasonography

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Footnotes

  • Collaborators No.

  • Contributors HL: Participated in study design and dissection, data analysis, and manuscript preparation. Attestation: HL approved the final manuscript. Conflicts of interest: None. CH: Participated in study design and manuscript preparation. Attestation: CH approved the final manuscript. Conflicts of interest: None. JC: Participated in manuscript preparation. Attestation: JC approved the final manuscript. Conflicts of interest: None. LV-V: Participated in study design and manuscript preparation.Attestation: LV-V approved the final manuscript. Conflicts of interest: None. AP-G: Participated in manuscript preparation. Attestation: AP-G approved the final manuscript. Conflicts of interest: None. XSB: Participated in study design and dissection, data analysis, and manuscript preparation. Attestation: XSB approved the final manuscript. Conflicts of interest: None .

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.