Clavipectoral fascia block associated with intermediate cervical plexus block versus intermediate cervical plexus block alone in clavicle surgeries: a randomized clinical trial

Midshaft clavicle fractures account for approximately 5% of all bone fractures and frequently require surgical fixation to restore shoulder function. Regional anesthesia techniques are commonly used to improve perioperative analgesia for these procedures; however, the optimal strategy for clavicle surgery remains uncertain. This randomized clinical trial aimed to evaluate whether adding a clavipectoral fascia plane block (CFPB) to an intermediate cervical plexus block (ICPB) improves immediate postoperative analgesia compared with ICPB alone. In this prospective randomized double-blind trial, 40 adult patients undergoing surgical fixation of midshaft clavicle fractures under general anesthesia were randomly assigned to receive either ICPB combined with CFPB (intervention group) or ICPB alone (control group). All regional blocks were performed under ultrasound guidance using a 38-mm linear transducer. The primary outcome was morphine consumption in the post-anesthesia care unit (PACU). Secondary outcomes included PACU length of stay and perioperative adverse events. Data were analyzed using non-parametric methods, and effect sizes were estimated using Hodges–Lehmann median differences with 95% confidence intervals. Median (interquartile range) morphine consumption in the PACU was 0 (0–0) mg in the intervention group and 0 (0–3) mg in the control group ( p = 0.149). The estimated median difference between groups was 0 mg (95% CI − 1 to 0 mg). Median PACU length of stay was 60 (60–82.5) minutes in the intervention group and 75 (60–90) minutes in the control group ( p = 0.174), corresponding to an estimated median difference of − 10 min (95% CI − 25 to 5 min). No patients developed dyspnea, signs of Horner’s syndrome, or other complications related to the regional anesthesia techniques. In this randomized clinical trial, the addition of a clavipectoral fascia plane block to an intermediate cervical plexus block was not associated with a statistically significant reduction in immediate postoperative morphine consumption or PACU length of stay. However, given the unexpectedly low opioid consumption and the resulting floor effect, modest differences between interventions cannot be excluded. Larger adequately powered studies are required to better define the role of combined regional anesthesia techniques in clavicle surgery. The study was registered with the Brazilian Registry of Clinical Trials (ReBEC) under number U1111-1255-2364.