BACKGROUND: Regional anesthesia such as interscalene brachial plexus block (ISBPB) with intermediate cervical plexus block (ICPB) is generally a preferred choice for clavicular surgery. However, various studies have shown that these blocks, especially ISBPB, could cause phrenic nerve paralysis and decrease diaphragmatic motion. The study aimed to evaluate the efficacy of clavipectoral fascial plane block (CPB), an alternative technique to ISBPB, with ICPB, in reducing hemidiaphragmatic paralysis during midshaft clavicular surgery. METHODS: Forty patients scheduled for right midshaft clavicular surgery were randomized (1:1) into an ultrasound-guided ISBPB with ICPB (BC) group or ultrasound-guided CPB with ICPB (CC) group. Five milliliter of 0.375% ropivacaine was used for ICPB, another 20 mL for ISBPB or CPB, and no administration of additional sedative or general anesthetic was planned. Primary outcome was measured by the incidence of hemidiaphragmatic paralysis using M-mode ultrasonography, while secondary outcomes were measured by bedside pulmonary function test, the success rate of block, the time required for the block procedure and onset of block, and motor block score in right upper extremity. RESULTS: In comparison with BC group, the incidence of hemidiaphragmatic paralysis postblock was decreased in CC group (50% vs 0%; P < .001), and measurement of bedside pulmonary function was significantly improved. There was a 100% success rate for anesthetic block in both BC and CC groups, and CC group showed lower motor block score in upper extremity and less block procedure time than BC group (7.1 ± 1.2 vs 3.2 ± 0.6 minutes; P < .001). Moreover, no significant differences were found between time of onset of block and other anesthetic complications in the 2 groups. CONCLUSIONS: Ultrasound-guided CPB with ICPB could significantly reduce hemidiaphragmatic paralysis and provide an adequate surgical anesthesia with fewer complications such as motor block in upper extremity during right midshaft clavicular surgery. (Anesth Analg 2022;135:633-40) KEY POINTS • Question: Can ultrasound-guided clavipectoral fascial plane block with intermediate cervical plexus block reduce hemidiaphragmatic paralysis during clavicular surgery? • Findings: Ultrasound-guided clavipectoral fascial plane block with intermediate cervical plexus block decreased the incidence of hemidiaphragmatic paralysis while providing an adequate surgical anesthesia for midshaft clavicular surgery with minimal motor block in upper extremity. • Meaning: Ultrasound-guided clavipectoral fascial plane block with intermediate cervical plexus block appears to be a promising anesthetic technique for midshaft clavicular surgery.GLOSSARY ANOVA = analysis of variance; ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; CL = clavicle; CONSORT = Consolidated Standards of Reporting Trials; CPB = clavipectoral fascial plane block; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; HR = heart rate; ICPB = i...

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