Awake clavicle surgery with PECS1 and ultrasound selective supraclavicular nerve block combination

Sanllorente-Sebastián, Rodrigo; Wilk, Piotr; Garcés-Pérez, Gloria María; Arias-Rodríguez, Luis; Andrés-Pedrosa, M.; Martínez-Ibeas, E.

doi:10.1016/j.jclinane.2020.109937

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…In addition, the anatomy of the inferior branch of transverse cervical nerve along with the medial branch of supraclavicular nerve are mainly responsible for skin sensation in the area of thyroid surgeries. It has been reported that the anesthesia effect is satisfied through blocking the supraclavicular nerve in clavicle surgeries while patients are awake [ 13 ]. However, due to the specific thin and scattered structure of the inferior branch of the transverse cervical nerve as well as the medial branch of supraclavicular nerve, traditional percutaneous injection in the superficial cervical plexus block is difficult to locate and is mostly dependent on a larger dose of tissue dispersion to achieve an anesthetic effect in practice.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Precision Approach to Intraoperative Ropivacaine Nerve Block to Improve Postoperative Analgesia in 120 Patients Undergoing Thyroid Surgery

et al. 2022

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Background This study aimed to compare a precision approach to intraoperative nerve block with traditional analgesia to reduce postoperative pain in 120 patients during thyroid surgery. The precision intraoperative technique used 0.3% ropivacaine to block the lower branch of the transverse cervical nerve and the inner branches of the supraclavicular nerve. Material/Methods A total of 120 patients were prospectively enrolled in this study. All patients were randomly and evenly divided into 3 groups. In the precision group, 0.3% ropivacaine was used through the wound during surgery. In the traditional group, a superficial cervical plexus nerve block was performed before surgery. Saline was injected in the control group. The valuation of postoperative pain was assessed using the visual analogue scale (VAS). Results Two hours after surgery, the VAS scores in the precision group, traditional group, and control group were 1.4±0.5, 1.6±0.7, and 2.8±1.0 ( P <0.001), respectively. Then, the pain improvement was more significant after 6 h, as the VAS scores in the precision, traditional, and control groups were 1.0±0.5, 1.2±0.6, and 2.6±1.1 ( P <0.001), respectively. Twenty-four hours after surgery, the VAS scores in the precision, traditional, and control groups were 0.7±0.3, 0.6±0.4, and 1.9±1.1 ( P <0.001), respectively. Conclusions At a single center, the use of a precision intraoperative ropivacaine nerve block significantly reduced postoperative pain when compared with traditional analgesia for patients undergoing thyroid surgery.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a Precision Approach to Intraoperative Ropivacaine Nerve Block to Improve Postoperative Analgesia in 120 Patients Undergoing Thyroid Surgery

et al. 2022

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“…The supraclavicular nerve, which has been categorized as a superficial cervical plexus, arises from the C3‐C4 nerve roots and supplies the upper chest area and shoulder 4–9 . Selective supraclavicular nerve blocks (SSCNB) have been used for anesthesia or analgesia in surgical procedures of the clavicle and shoulder with different local anesthetic drugs 5–8,10,11 . When implanting the Hickman catheter or chemoport, the needle was inserted 1 cm above the sternoclavicular joint for venous puncture and the skin incision was made about 2 cm below the clavicle with the catheter tunneling between them, which is mainly innervated by the supraclavicular nerves 12 .…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8][9] Selective supraclavicular nerve blocks (SSCNB) have been used for anesthesia or analgesia in surgical procedures of the clavicle and shoulder with different local anesthetic drugs. [5][6][7][8]10,11 When implanting the Hickman catheter or chemoport, the needle was inserted 1 cm above the sternoclavicular joint for venous puncture and the skin incision was made about 2 cm below the clavicle with the catheter tunneling between them, which is mainly innervated by the supraclavicular nerves. 12 The superficial cervical plexus block showed satisfactory analgesic effects, with fewer complications, in patients who underwent central venous catheter insertion in a previous study.…”

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confidence: 99%

Ultrasound‐guided selective supraclavicular nerve block for postoperative pain control in children receiving Hickman catheter or chemoport insertion: A randomized controlled trial

Park,

Song,

Kang

et al. 2023

Pediatric Anesthesia

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BackgroundOptimal pain management after insertion of a central venous catheter in children remains unclear.AimThis study aimed to evaluate the effects of a selective supraclavicular nerve block on postoperative analgesia in pediatric patients undergoing hickman catheter or chemoport insertion.MethodsFifty patients aged 3–18 years scheduled for elective Hickman or chemoport insertion were randomized into two groups of 25 each: one group received an ultrasound‐guided selective supraclavicular nerve block with 0.1 mL/kg of 0.5% ropivacaine (SSCNB group), and the other group did not receive a nerve block (control group). The primary outcome was the postoperative Wong‐Baker Faces Pain Rating Scale score measured between 10 and 30 min after surgery. Secondary outcomes included pain scores at 1, 3, and 24 h after the surgery, block‐related complications, length of stay in the postanesthesia care unit, postoperative analgesic consumption, and time to first analgesic use 24 h after surgery.ResultsThe worst pain score within 30 min in the recovery room was significantly lower in the SSCNB group compared to the control group (6 [5–7] vs. 3 [2–4]; median difference, −3; 95% CI, −4 to −1; p < .001). Pain scores at 1, 3, and 24 h after surgery were also significantly lower in the SSCNB group. The need for both opioid and non‐opioid analgesics in the postoperative period was significantly lower in the SSCNB group (36.0% vs. 0%; p = .002 and 44.0% vs. 16.0%; mean difference, −28%; 95% CI, −56 to 0.19; p = .033, respectively), while other secondary outcomes were not significantly different between the two groups.ConclusionsUltrasound‐guided SSCNB is an effective method for managing postoperative pain in children undergoing Hickman catheter or chemoport insertion, reducing the need for analgesics within 24 h after surgery.

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“…Plexus blocks involve the cervical plexus (superficial cervical plexus block or selective supraclavicular nerve block) with or without brachial plexus (interscalene or selective superior trunk) blocks. While the plexus blocks are associated with motor weakness of the upper extremity, the efficacy of the truncal blocks like erector spinae plane block [ 11 ] or the pectoral nerve blocks [ 12 - 13 ] (PEC1 and PEC2) is yet to be determined. The clavipectoral fascial plane block (CPB) can provide anesthesia or analgesia for CF, eliminating the disadvantages of plexus blocks [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Awake Single-Stage Bilateral Clavicle Surgeries Under a Bilateral Clavipectoral Fascial Plane Block: A Case Report and Review of Literature

Sonawane¹,

Dharmapuri²,

Saxena³

et al. 2021

Cureus

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The clavicle is a frequently fractured bone with an infrequent bilateral occurrence. Regional anesthesia (RA) for clavicle surgeries is always challenging due to its complex innervation arising from the two plexuses (cervical and brachial). Various RA techniques described for clavicle surgeries include plexus blocks, fascial plane blocks, and truncal blocks. Plexus blocks are associated with undesirable effects, such as phrenic nerve blockade and paralysis of the entire upper limb, limiting their application for bilateral regional clavicle surgeries. The clavipectoral fascial plane block (CPB) is a novel, procedure-specific, phrenic-sparing, and motor-sparing RA technique that can provide anesthesia or analgesia for clavicle surgeries. The decision to use the CPB and/or other RA techniques may depend on the site of clavicle injury or variations in clavicular innervation.We report a case of single-stage bilateral clavicle surgery successfully managed with a bilateral CPB alone using ultrasound guidance and landmark guidance separately. The patient was kept awake and comfortable throughout the surgery.In conclusion, CPB can be an effective alternate RA technique in avoiding undesired side effects of more proximal techniques such as phrenic nerve involvement and motor blockade of upper limbs. Landmarkguided CPB can be an alternative with equianalgesic efficacy as of ultrasound-guided CPB in resource-poor or emergency settings.

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Awake clavicle surgery with PECS1 and ultrasound selective supraclavicular nerve block combination

Cited by 6 publications

References 7 publications

Evaluation of a Precision Approach to Intraoperative Ropivacaine Nerve Block to Improve Postoperative Analgesia in 120 Patients Undergoing Thyroid Surgery

Evaluation of a Precision Approach to Intraoperative Ropivacaine Nerve Block to Improve Postoperative Analgesia in 120 Patients Undergoing Thyroid Surgery

Ultrasound‐guided selective supraclavicular nerve block for postoperative pain control in children receiving Hickman catheter or chemoport insertion: A randomized controlled trial

Awake Single-Stage Bilateral Clavicle Surgeries Under a Bilateral Clavipectoral Fascial Plane Block: A Case Report and Review of Literature

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