Interscalene brachial plexus block for surgical repair of clavicle fracture: a matched case-controlled study

Magnus Olofsson,Patrick Taffé,Frédéric Vauclair,Eric Albrecht,Bénédict Morin,Kyle Robert Kirkham

doi:10.1186/s12871-020-01005-x

Abstract

BackgroundInnervation of the clavicle is complex and debated, with scarce data on the analgesic and clinical impact of regional anaesthesia after surgical repair of clavicle fracture.MethodsIn order to assess the analgesic efficiency of an interscalene brachial plexus block (ISB) for surgical repair of clavicle fracture, 50 consecutive patients scheduled for surgical fixation of middle/lateral clavicle fracture under general anaesthesia with ISB were prospectively enrolled. This cohort was compared to a historical control of 76 retrospective patients without regional block. The primary outcome was total intravenous morphine equivalent consumption at 2 postoperative hours. To assess the ISB impact, both an overall cohort analysis and a case-matched analysis with each ISB-treated patient matched to a Non-ISB-treated patient was performed. Matching employed a 1-to-1, nearest-neighbour approach using the Mahalanobis metric.ResultsIn the overall cohort, patients with ISB had significantly lower i.v. morphine equivalent consumption at 2 postoperative hours (0.7 mg (95% CI 0.1 to 1.2) versus controls 8.8 mg (95% CI 7.1 to 10.4); P < 0.0001). These results persisted after case-matching the cohorts (mean difference for the primary outcome: 8.3 mg (95% CI 6.5 to 10.0); P < 0.001).ConclusionsISB provides effective analgesia after surgical fixation of middle and lateral clavicle fracture. These results should help physicians in establishing an analgesic strategy for this type of surgery. Further research is needed to identify the optimal regional technique for medial third clavicle fractures and the clinically relevant contributions of the cervical and brachial plexus.Trial registrationClinicaltrials.gov – NCT02565342, October 1st 2015.

Highlights

Innervation of the clavicle is complex and debated, with scarce data on the analgesic and clinical impact of regional anaesthesia after surgical repair of clavicle fracture
With the goal to resolve this clinical dilemma, we undertook a matched case-control cohort study assessing the analgesic impact of ultrasoundguided interscalene brachial plexus block (US-ISB) for patients scheduled for open reduction and internal fixation (ORIF) of middle or lateral clavicle fracture
Primary outcome Before matching, patients who received the US-ISB had a significantly lower i.v. morphine equivalent consumption at 2 postoperative hours (0.7 mg (CI 95% 0.1 to 1.2)) compared to control patients (8.8 mg (CI 95% 7.1 to 10.4); P < 0.0001; Fig. 1)

Summary

Introduction

Innervation of the clavicle is complex and debated, with scarce data on the analgesic and clinical impact of regional anaesthesia after surgical repair of clavicle fracture. Surgical fixation of clavicular fractures may result in moderate to severe postoperative pain that does not always respond well to opioid therapy. A regional technique may represent an analgesic improvement with the potential to reduce postoperative opioid consumption [1,2,3]. Innervation of the Olofsson et al BMC Anesthesiology (2020) 20:91 clavicular fractures. With the goal to resolve this clinical dilemma, we undertook a matched case-control cohort study assessing the analgesic impact of ultrasoundguided interscalene brachial plexus block (US-ISB) for patients scheduled for open reduction and internal fixation (ORIF) of middle or lateral clavicle fracture

Methods

Results

Discussion

Conclusion