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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Ultrasound-guided clavipectoral fascia plane block for middle third clavicular f...
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Vol. 69. Issue 10.
Pages 683-688 (December 2022)
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Vol. 69. Issue 10.
Pages 683-688 (December 2022)
Case report
Ultrasound-guided clavipectoral fascia plane block for middle third clavicular fracture: A case series
Bloqueo del plano de la fascia clavipectoral guiada por ultrasonido para fractura del tercio medio clavicular: una serie de casos
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H. Labandeyraa,
Corresponding author
hipolitolabandeyra@gmail.com

Corresponding author.
, J.L. Furnob, J.L. Camposa, V. Roqués Escolarc, L.F. Valdés Vilchesd
a Fellowship Sanatorio Mapaci, Rosario, Santa Fe, Argentina
b Sanatorio Mapaci, Rosario, Santa Fe, Argentina
c Hospital Virgen de la Arrixaca, Murcia, Spain
d Hospital Costa del Sol, Marbella, Málaga, Spain
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Abstract
Background and objective

Clavipectoral fascia plane block has been described as an anaesthetic and analgesic strategy for osteosynthesis of midclavicular fractures. However, to date, only isolated cases have been published. The aim of this study was to evaluate the anaesthetic and analgesic efficacy of this new approach in midclavicular fracture surgery in a large case series.

Material and methods

Descriptive, observational study of 50 patients undergoing osteosynthesis of middle third clavicular fracture who received CPB block associated with supraclavicular nerve block. The primary objective was to assess pain on a VAS scale in the immediate postoperative period, and at 6, 12 and 24h. Secondary objectives were to determine the degree of intraoperative sedation, perioperative morphine consumption, need for rescue analgesia, unplanned general anaesthesia, presence of motor and sensory blockade, and diagnosis of diaphragmatic paralysis.

Results

Postoperative pain was 1.04 (SD=1.26) in the immediate postoperative period; 1.24 (SD=1.42) at 6h; 1.34 (SD=1.92) at 12h; and 0.96 (SD=1.29) at 24h. Mean total intraoperative fentanyl dose was 0.88μg/kg. Postoperatively, nine patients (18%) requested rescue analgesia. There were no conversions to general anaesthesia, no motor or sensory blockade of upper extremities, and no hemidiaphragmatic paralysis.

Conclusions

Our series supports the anaesthetic and analgesic efficacy of CPB block for osteosynthesis of midclavicular fractures.

Keywords:
Clavipectoral fascia
Nerve block
Postoperative pain
Upper extremity
Diaphragmatic paralysis
Resumen
Antecedentes y objetivo

El bloqueo del plano de la fascia clavipectoral se ha descrito como una estrategia anestésica y analgésica para la cirugía de osteosíntesis de las fracturas del tercio medio clavicular. Pero, hasta el momento, sólo hay publicados casos aislados. El objetivo de este estudio fue evaluar la eficacia anestésica y analgésica de este nuevo abordaje en cirugía de fractura de tercio medio clavicular en una amplia serie de casos.

Material y métodos

Estudio descriptivo, observacional, de 50 pacientes intervenidos para osteosíntesis de fractura de tercio medio clavicular mediante un bloqueo CPB asociado a un bloqueo del nervio supraclavicular. Como objetivo primario se evaluó el dolor mediante escala visual análoga (VAS) en el postoperatorio inmediato, a las 6-12-24h. Como objetivos secundarios se midió el grado de sedación intraoperatorio, consumo de morfínicos perioperatorio, necesidad de analgesia de rescate, anestesia general no planificada, presencia de bloqueo motor y sensitivo, y diagnóstico de parálisis diafragmática.

Resultados

El dolor postoperatorio fue de 1,04 (DE=1,26) en el postoperatorio inmediato; 1,24 (DE=1,42) a las 6h; 1,34 (DE=1,92) a las 12h; y 0,96 (DE=1,29) a las 24h. La dosis total de fentanilo intraoperatorio promedio fue de 0,88μg/kg. Durante el postoperatorio, Nueve pacientes (18%) solicitaron analgesia de rescate. No hubo reconversiones a anestesia general, no se objetivó bloqueo motor o sensitivo de la extremidad superior, ni parálisis diafragmática.

Conclusiones

Nuestra serie apoya la eficacia anestésica y analgésica del bloqueo CPB para la osteosíntesis de fracturas de tercio medio clavicular.

Palabras clave:
Fascia clavipectoral
Bloqueo nervioso
Dolor postoperatorio
Extremidad superior
Parálisis diafragmática

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