P088 Clavipectoral fascial plane block combined with blockade of the supraclavicular nerves for surgical anaesthesia of the clavicle in a high risk patient with multiple rib fractures

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Ipsilateral phrenic nerve blockade is a common adverse event after a brachial plexus block above the clavicle. Clavipectoral fascial plane block (CPB) is a phrenic nerve-sparing, motor-sparing regional technique for clavicle fracture surgeries. <h3>Methods</h3> A 58-year-old male, ASA II patient had suffered a high-energy blunt thoracic trauma from a road traffic accident. CT Thorax showed left-sided anterolateral fractures of ribs 3 to 6, concomitant lung contusion on the ipsilateral side, and an open left midshaft clavicle fracture. Only the clavicle fracture required surgical fixation. An ultrasound-guided deep serratus anterior (SAP) catheter was placed and 20 mL 0.125% bupivacaine was administered through the catheter to provide analgesia before the surgery. To avoid general anaesthesia and the potential complications of mechanical ventilation for the clavicle surgery, we administered surgical anaesthesia by performing a single-shot ultrasound-guided clavipectoral fascial plane block using 10 mL 0.375% bupivacaine on each side of the fracture site and a selective blockade of the supraclavicular nerves using 3 mL of 0.375% bupivacaine. 8 mg of iv dexamethasone was administered as adjuvant. During the surgery, we administered Propofol sedation (TCI Marsh model Cet 1.5mcg/ml). <h3>Results</h3> The block provided complete surgical anaesthesia The 75-minute-long operation was pain-free and no opioids were administered. The SAP catheter provided adequate analgesia postoperatively for 5 days. <h3>Conclusions</h3> This combination of regional techniques resulted in an effective and safe anaesthesia. With the ultrasound-guided CPB we were able to avoid the general anaesthesia in a high risk patient, with excellent analgesia and phrenic-nerve sparing effect.