Reimagining clavicle fracture anaesthesia: the rise of the clavipectoral block- a case series

Clavicle fractures account for approximately 2.6% of all fractures and are commonly managed surgically under general anaesthesia. Conventional regional techniques such as interscalene and supraclavicular blocks may provide analgesia but can be associated with phrenic nerve palsy, respiratory compromise, and upper-limb motor blockade. The clavipectoral fascia block (CPB), with or without superficial cervical plexus block (SCPB), has emerged as a potential alternative for clavicular surgery. We report a case series of six ASA I–II patients undergoing unilateral clavicular fracture fixation under ultrasound-guided CPB. A superficial cervical plexus block or local infiltration (if USG guided SCPB administration is found anatomically difficult or when deemed necessary for cutaneous analgesia) was added when additional analgesia was required. Sedation was provided with midazolam, fentanyl, and dexmedetomidine infusion. The primary outcomes assessed were adequacy of surgical anaesthesia, need for conversion to general anaesthesia, postoperative Visual Analog scale VAS analgesia pain score and complications. Five of six patients underwent successful open reduction and internal fixation without conversion to general anaesthesia. Adequate intraoperative analgesia was achieved in all successful cases. Postoperative analgesia lasted 8–12 h, and only two doses of paracetamol were required during the first 24 h. No major complications, respiratory compromise, or neurovascular deficits were observed. One patient with a displaced lateral-end clavicular fracture required conversion to general anaesthesia because oedema and haematoma distorted the clavipectoral fascial plane and limited local anaesthetic spread. Other patient admitted for surgery, requested conversion to general anaesthesia due to perioperative anxiety, despite the successful administration of the block. The clavipectoral fascia block is a safe and effective regional anaesthetic technique for clavicular fracture surgery and may be particularly useful in patients with significant respiratory comorbidity.