ANESTHETIC MANAGEMENT OF A PATIENT WITH FRACTURED CLAVICLE WITH PLATE IN SITU ROLE OF SITE-SPECIFIC NERVE BLOCK – A CASE REPORT
Keywords:Fracture, Clavicle, Anesthesia, Regional, Nerve blocks
Surgery of the clavicle with fixation of plate is being done more commonly in the recent years with an intention to give optimal functional outcomes. A repeat injury with broken clavicle with plate in situ is relatively rare. A 30-year-old 90 kg male with a BMI of 30 was posted for open reduction and fixation. There was no comorbid illness except a difficult airway. The routine investigations were normal. The plan was to administer Partha’s combo block as the patient was obese with difficult airway. There was laceration in the side of front of neck which was painful. An ultrasound-guided superficial cervical plexus block with 5 ml of 0.5% bupivacaine was given to block the side of front of neck and the skin in front of clavicle. This provided a pain-free needling of brachial plexus. The upper trunk of the brachial plexus was blocked with 8 ml of 0.5% bupivacaine. Another 15 ml of 0.25% bupivacaine was administered in the Clavipectoral fascia plane to knock out any possible failure of the above blocks. The presence of a plate and a previous scar made the block challenging. Three milliliters of 0.25% bupivacaine were used in the middle of chest to block the nerves from the other side. The surgery was uneventful and the duration was 2 h. Only 25 μg of intravenous fentanyl was used intraoperatively. This case report is presented for its rarity, where a non-virgin clavicle was fixed with combined site-specific blocks in an obese patient with difficult airway.
Ryan DJ, Iofin N, Furgiuele D, Johnson J, Egol K. Regional anesthesia for clavicle fracture surgery is safe and effective. J Shoulder Elbow Surg 2021;30:e356-60. doi: 10.1016/j.jse.2020.10.009. Epub 2020 Nov 13.
Balaban O, Dülgeroğlu TC, Aydın T. Ultrasound-guided combined interscalene-cervical plexus block for surgical anesthesia in clavicular fractures: A retrospective observational study. Anesthesiol Res Pract 2018;2018:7842128. doi: 10.1155/2018/7842128. PMID: 29973954; PMCID: PMC6008659.
Sivashanmugam T, Areti A, Selvum E, Diwan S, Pandian A. 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. Indian J Anaesth 2021;65:656- 61. doi:10.4103/ija.ija_255_21. Epub 2021 Oct 8. PMID: 34764500; PMCID: PMC8577712.
Inan M, Parthasarathy S. Combined cervical plexus and upper trunk block as a regional anaesthesia technique for successful insertion of permanent pacemaker. Indian J Anaesth 2021;65:496-7. doi:10.4103/ ija.IJA_1576_20. Epub 2021 Jun 22. PMID: 34248199; PMCID: PMC8252995.
Kukreja P, Davis CJ, MacBeth L, Feinstein J, Kalagara H. Ultrasound-guided clavipectoral fascial plane block for surgery involving the clavicle: A case series. Cureus 2020;12:e9072. doi: 10.7759/ cureus.9072. PMID: 32782888; PMCID: PMC7413568.
Yoshimura M, Morimoto Y. Use of clavipectoral fascial plane block for clavicle fracture: Two case reports. Saudi J Anaesth 2020;14:284- 5. doi: 10.4103/sja.SJA_52_20. Epub 2020 Mar 5. PMID: 32317907; PMCID: PMC7164465.
Sonawane K, Dixit H, Balavenkatasubramanian J, Gurumoorthi P. Uncovering secrets of the beauty bone: A comprehensive review of anatomy and regional anesthesia techniques of clavicle surgeries. Open J Orthop Rheumatol 2021;6:19-29. DOI: 10.17352/ojor.000034
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