Clavipectoral fascia plane block in midshaft clavicle fractures: A cadaveric study.

STUDY OBJECTIVE: The objective of this anatomical study was to investigate the distribution of a solution administered using the Clavipectoral Fascia Plane Block (CPB) technique in a series of cadaveric models with midshaft clavicular fractures. The study aimed to address the knowledge gap regarding the impact of clavicular fractures on the distribution pattern of the CPB-administered solution. DESIGN: Observational cadaveric study. SETTING: The research was conducted in the laboratory setting of the University of Barcelona, adhering to the institution's ethical guidelines and standards. PATIENTS: Five unembalmed human cadavers were used, generating ten clavicle samples. INTERVENTIONS: A postmortem fracture was induced in the middle third of the clavicle using a blunt-edged hammer, simulating a midshaft clavicular fracture. MEASUREMENTS: Anatomical dissection was performed in three layers: the superficial muscle plane, deep muscle plane, and clavicular periosteum plane. Dye staining with methylene blue was utilized to assess the distribution pattern. MAIN RESULTS: In the superficial muscular plane, methylene blue was observed in the deltoid (100%), pectoralis major (100%), sternocleidomastoid (SCM) (70%), and trapezius muscles (100%). Conversely, the deep muscular plane, including the subclavius muscle, pectoralis minor, and Clavipectoral Fascia (CPF), exhibited no staining. At the clavicular periosteum plane, methylene blue distributed predominantly to the antero-superior region (57.3%), with a minimal impact on the postero-inferior area (6.5%). CONCLUSIONS: The study reveals that the presence of a midshaft clavicular fracture does not significantly alter the diffusion pattern of the CPB-administered solution, maintaining a consistent distribution in both intact and fractured clavicle models.

Clavipectoral Fascia Plane Block Combined With Superficial Cervical Plexus Block for the Removal of Osteosynthesis Material From Clavicle Fracture.

Clavipectoral fascial plane block combined with superficial cervical plexus block has been used as an anesthetic and analgesic technique in mid-clavicle fracture surgeries. The authors describe two cases in which patients underwent extraction of osteosynthesis material from the clavicle, using clavipectoral fascial plane block combined with superficial cervical plexus block as an anesthetic and analgesic technique in the postoperative period. The mentioned block presented itself as an easy-to-perform technique, apparently safe and effective, allowing to obtain satisfactory results.

Effect of Clavipectoral Fascia Suturing on Postmastectomy Seroma Formation.

<b><br>Introduction:</b> Post-mastectomy seroma formation is a challenging sequela which has a negative impact on patient recovery and quality of life.</br> <b><br>Aim:</b> We aim to publicize our technique of clavipectoral fascia re-closure and to assess its efficacy in reducing the incidence of seroma formation.</br> <b><br>Methods:</b> This is a prospective randomized controlled trial, conducted in South Cancer institute, Assiut University, Egypt. It included 84 breast cancer patients who were randomly divided into two groups: a control group (n = 44) and a fascia suture group (n = 40). The patients were followed up until drain removal and then to 3 months after surgery.</br> <b><br>Results:</b> The fascia suture group showed significantly shorter duration of drain removal with a significant reduction in the total amount of drained fluid and the amount of drained fluid 1 week postoperatively. One patient in the fascia suture group developed Grade 2-3 seroma vs. 7 in the control group (P < 0.05).</br> <b><br>Conclusions:</b> Clavipectoral fascia suture technique is a simple and effective method for reducing seroma formation after mastectomy in breast cancer patients and is advisable in patients at a high risk for seroma formation.</br>.

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.

Variation of serratus anterior muscle originated from the clavipectoral fascia: a case report / Variación del músculo serrato anterior originado en la fascia clavipectoral: reporte de un caso

SUMMARY: The variations in the serratus anterior (SA) muscle are common. Here, we report a rare variation of the muscle origin with a potentially great clinical implication. We found an aberrant SA variation in an 81-year-old Korean male cadaver during a routine dissection for medical students. Additional slip (AS) of the SA originated from the clavipectoral fascia and the pectoralis minor. It traveled inferiorly and merged to the typical SA part. Precise knowledge about SA variations is clinically valuable; therefore, clinicians should be aware of the possible variation.

RESUMEN: Las variaciones en el músculo serrato anterior (MSA) son comunes. En este trabajo informamos una variación rara del origen muscular con una implicación clínica potencialmente importante. Encontramos una variación aberrante del MSA en un cadáver masculino, coreano de 81 años, durante una disección de rutina para estudiantes de medicina, con un fascículo adicional del MSA originado en la fascia clavipectoral y el músculo pectoral menor. Este fascículo se dirigió inferiormente y se fu- sionó con la parte común de MSA. El conocimiento preciso sobre las variaciones de MSA es útil clínicamente; por lo tanto, los médicos deben ser conscientes de esta posible variación.

Bloqueo del plano de la fascia clavipectoral guiada por ultrasonido / Ultrasound-guided clavipectoral fascia plane block

The case of a patient with clavicular middle third fractures is presented. The aim is explaining the ultrasound guided clavipectoral fascia plane block (CPB). This constitutes a novel technique and an alternative to traditional regional anesthesia of the brachial plexus. The purpose is to provide anesthesia, analgesia, and control over postoperative pain about the pathology mentioned. The technique was first described by L. Valdés in 2017.

Se presenta el caso de una paciente con fractura de tercio medio clavicular con el objetivo de explicar el bloqueo del plano de la fascia clavipectoral guiado por ultrasonido (CPB). Ésta constituye una técnica novedosa y una alternativa a los procedimientos tradicionales de anestesia regional del plexo braquial, con el propósito de brindar anestesia, analgesia y control del dolor posoperatorio sobre dicha patología. Esta técnica fue descrita por primera vez en el año 2017 por L. Valdés.