Bloqueo del plano de la fascia clavipectoral guiada por ultrasonido para fractura del tercio medio clavicular: una serie de casos / Ultrasound-guided clavipectoral fascia plane block for middle third clavicular fracture: A case series

Antecedentes y objetivo: El bloqueo del plano de la fascia clavipectoral se ha descrito como una estrategia anestésica y analgésica para la cirugía de osteosíntesis de las fracturas del tercio medio clavicular. Pero, hasta el momento, solo hay publicados casos aislados. El objetivo de este estudio fue evaluar la eficacia anestésica y analgésica de este nuevo abordaje en cirugía de fractura de tercio medio clavicular en una amplia serie de casos. Material y métodos: Estudio descriptivo, observacional, de 50 pacientes intervenidos para osteosíntesis de fractura de tercio medio clavicular mediante un bloqueo del plano de la fascia clavipectoral asociado a un bloqueo del nervio supraclavicular. Como objetivo primario se evaluó el dolor mediante escala visual análoga en el postoperatorio inmediato y a las 6-12-24h. Como objetivos secundarios se midieron el grado de sedación intraoperatorio, el consumo de morfínicos perioperatorio, la necesidad de analgesia de rescate, la anestesia general no planificada, la presencia de bloqueo motor y sensitivo, y el diagnóstico de parálisis diafragmática. Resultados: El dolor postoperatorio fue de 1,04 (DE=1,26) en el postoperatorio inmediato; 1,24 (DE=1,42) a las 6h; 1,34 (DE=1,92) a las 12h, y 0,96 (DE=1,29) a las 24h. La dosis total de fentanilo intraoperatorio promedio fue de 0,88μg/kg. Durante el postoperatorio, 9 pacientes (18%) solicitaron analgesia de rescate. No hubo reconversiones a anestesia general, ni se objetivaron bloqueo motor o sensitivo de la extremidad superior ni parálisis diafragmática. Conclusiones: Nuestra serie apoya la eficacia anestésica y analgésica del bloqueo del plano de la fascia clavipectoral para la osteosíntesis de fracturas de tercio medio clavicular.(AU)

Background and objective: Clavipectoral fascia plane block has been described as an anaesthetic and analgesic strategy for osteosynthesis of midclavicular fractures. However, to date, only isolated cases have been published. The aim of this study was to evaluate the anaesthetic and analgesic efficacy of this new approach in midclavicular fracture surgery in a large case series. Material and methods: Descriptive, observational study of 50 patients undergoing osteosynthesis of middle third clavicular fracture who received clavipectoral fascia plane block associated with supraclavicular nerve block. The primary objective was to assess pain on a visual analog scale in the immediate postoperative period, and at 6, 12 and 24h. Secondary objectives were to determine the degree of intraoperative sedation, perioperative morphine consumption, need for rescue analgesia, unplanned general anaesthesia, presence of motor and sensory blockade, and diagnosis of diaphragmatic paralysis. Results: Postoperative pain was 1.04 (SD=1.26) in the immediate postoperative period; 1.24 (SD=1.42) at 6h; 1.34 (SD=1.92) at 12h, and 0.96 (SD=1.29) at 24h. Mean total intraoperative fentanyl dose was 0.88μg/kg. Postoperatively, 9 patients (18%) requested rescue analgesia. There were no conversions to general anaesthesia, no motor or sensory blockade of upper extremities, and no hemidiaphragmatic paralysis. Conclusions: Our series supports the anaesthetic and analgesic efficacy of clavipectoral fascia plane block for osteosynthesis of midclavicular fractures.(AU)

Bloqueo del plano de la fascia clavipectoral guiada por ultrasonido para fractura del tercio medio clavicular: una serie de casos / Ultrasound-guided clavipectoral fascia plane block for middle third clavicular fracture: A case series

Antecedentes y objetivo: El bloqueo del plano de la fascia clavipectoral se ha descrito como una estrategia anestésica y analgésica para la cirugía de osteosíntesis de las fracturas del tercio medio clavicular. Pero, hasta el momento, solo hay publicados casos aislados. El objetivo de este estudio fue evaluar la eficacia anestésica y analgésica de este nuevo abordaje en cirugía de fractura de tercio medio clavicular en una amplia serie de casos. Material y métodos: Estudio descriptivo, observacional, de 50 pacientes intervenidos para osteosíntesis de fractura de tercio medio clavicular mediante un bloqueo del plano de la fascia clavipectoral asociado a un bloqueo del nervio supraclavicular. Como objetivo primario se evaluó el dolor mediante escala visual análoga en el postoperatorio inmediato y a las 6-12-24h. Como objetivos secundarios se midieron el grado de sedación intraoperatorio, el consumo de morfínicos perioperatorio, la necesidad de analgesia de rescate, la anestesia general no planificada, la presencia de bloqueo motor y sensitivo, y el diagnóstico de parálisis diafragmática. Resultados: El dolor postoperatorio fue de 1,04 (DE=1,26) en el postoperatorio inmediato; 1,24 (DE=1,42) a las 6h; 1,34 (DE=1,92) a las 12h, y 0,96 (DE=1,29) a las 24h. La dosis total de fentanilo intraoperatorio promedio fue de 0,88μg/kg. Durante el postoperatorio, 9 pacientes (18%) solicitaron analgesia de rescate. No hubo reconversiones a anestesia general, ni se objetivaron bloqueo motor o sensitivo de la extremidad superior ni parálisis diafragmática. Conclusiones: Nuestra serie apoya la eficacia anestésica y analgésica del bloqueo del plano de la fascia clavipectoral para la osteosíntesis de fracturas de tercio medio clavicular.(AU)

Background and objective: Clavipectoral fascia plane block has been described as an anaesthetic and analgesic strategy for osteosynthesis of midclavicular fractures. However, to date, only isolated cases have been published. The aim of this study was to evaluate the anaesthetic and analgesic efficacy of this new approach in midclavicular fracture surgery in a large case series. Material and methods: Descriptive, observational study of 50 patients undergoing osteosynthesis of middle third clavicular fracture who received clavipectoral fascia plane block associated with supraclavicular nerve block. The primary objective was to assess pain on a visual analog scale in the immediate postoperative period, and at 6, 12 and 24h. Secondary objectives were to determine the degree of intraoperative sedation, perioperative morphine consumption, need for rescue analgesia, unplanned general anaesthesia, presence of motor and sensory blockade, and diagnosis of diaphragmatic paralysis. Results: Postoperative pain was 1.04 (SD=1.26) in the immediate postoperative period; 1.24 (SD=1.42) at 6h; 1.34 (SD=1.92) at 12h, and 0.96 (SD=1.29) at 24h. Mean total intraoperative fentanyl dose was 0.88μg/kg. Postoperatively, 9 patients (18%) requested rescue analgesia. There were no conversions to general anaesthesia, no motor or sensory blockade of upper extremities, and no hemidiaphragmatic paralysis. Conclusions: Our series supports the anaesthetic and analgesic efficacy of clavipectoral fascia plane block for osteosynthesis of midclavicular fractures.(AU)

Ultrasound-guided clavipectoral fascia plane block for middle third clavicular fracture: A case series.

BACKGROUND AND OBJECTIVE: Clavipectoral fascia plane block has been described as an anaesthetic and analgesic strategy for osteosynthesis of midclavicular fractures. However, to date, only isolated cases have been published. The aim of this study was to evaluate the anaesthetic and analgesic efficacy of this new approach in midclavicular fracture surgery in a large case series. MATERIAL AND METHODS: Descriptive, observational study of 50 patients undergoing osteosynthesis of middle third clavicular fracture who received CPB block associated with supraclavicular nerve block. The primary objective was to assess pain on a VAS scale in the immediate postoperative period, and at 6, 12 and 24h. Secondary objectives were to determine the degree of intraoperative sedation, perioperative morphine consumption, need for rescue analgesia, unplanned general anaesthesia, presence of motor and sensory blockade, and diagnosis of diaphragmatic paralysis. RESULTS: Postoperative pain was 1.04 (SD=1.26) in the immediate postoperative period; 1.24 (SD=1.42) at 6h; 1.34 (SD=1.92) at 12h; and 0.96 (SD=1.29) at 24h. Mean total intraoperative fentanyl dose was 0.88µg/kg. Postoperatively, nine patients (18%) requested rescue analgesia. There were no conversions to general anaesthesia, no motor or sensory blockade of upper extremities, and no hemidiaphragmatic paralysis. CONCLUSIONS: Our series supports the anaesthetic and analgesic efficacy of CPB block for osteosynthesis of midclavicular fractures.