Abstract
General anaesthesia has a priority in surgical interventions of clavicle; however, regional techniques may come to the fore in the presence of increased risk factors. The innervation of the clavicle region is very complex and has not been fully described; therefore, only a limited number of different regional anaesthesia approaches should be considered. Here, we present the management of a clavicle fracture with a combination of an interscalene block (ISB) and deep cervical plexus block (dCPB) in a patient with severe maxillo-facial trauma (MFT) and diaphragmatic hernia due to combat injury. A 35-year-old male admitted to the emergency room as a war-wounded patient had suffered MFT and an unstable clavicle defect during the Syrian War. A diaphragmatic hernia was also detected during examination. The patient underwent operation with regional anaesthesia of the clavicle under spontaneous respiration. With standard monitoring and sedation, ISB and dCPB were performed under ultrasound guidance with a mixture of 0.25% bupivacaine (20 mL) and 0.5% lidocaine (10 mL). In the perioperative period, the patient's vital signs remained stable. The patient had no pain during the surgery. We suggest that the combination of ISB and dCPB is an efficient option for management of clavicle fracture in patients with multiple comorbidities.
Highlights
Clavicle fractures represent 2.6% of all fractures and 44% of those in the shoulder girdle [1]
Proposed interventional strategies for clavicle fracture have included the combination of the cervical plexus block, and brachial plexus block
Since a possible block failure due to peripheral approaches could not be risked, a combination of ISB and deep cervical plexus block (dCPB) was chosen as a central approach
Summary
Clavicle fractures represent 2.6% of all fractures and 44% of those in the shoulder girdle [1]. Proposed interventional strategies for clavicle fracture have included the combination of the cervical plexus block, and brachial plexus block (interscalene block-ISB). Our aim in the present case was to achieve a successful anaesthesia level using ISB and deep cervical plexus block (dCPB) to manage the existing clavicle pathology while avoiding the complications of general anaesthesia in a patient with maxillo-facial trauma (MFT) and diaphragmatic hernia. Since a possible block failure due to peripheral approaches could not be risked, a combination of ISB and dCPB was chosen as a central approach This block was carried out in a semi-sitting position with the head slightly deviated to the opposite side in the operating room. The patient underwent reoperation under regional anaesthesia with ISB and C4 dCPB, the displaced intramedullary nail was removed and a clavicle plate was placed. The patient was discharged on the 4th postoperative day with recommendations
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