Could C3, 4, and 5 Nerve Root Block be a Better Alternative to Interscalene Block Plus Intermediate Cervical Plexus Block for Patients Undergoing Surgery for Midshaft and Medial Clavicle Fractures? A Randomized Controlled Trial

Han, Junde; Xu, Yang; Yu, Shijun; Xie, Yaming; Wang, Aizhong; Gu, Chentao

doi:10.1097/corr.0000000000002479

Cited by 3 publications

(3 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the 2 groups had no difference in the Numeric Rating Scale (NRS). Therefore, C3, C4, and C5 nerve blocks are a suitable RA method for middle clavicle fractures ( 20 ). Consequently, this study shows that RA approaches, which are more selective and less extensive, are as efficient as the conventional methods.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery

Mosaffa,

Ghasemi,

Habibi

et al. 2024

Anesth Pain Med

View full text Add to dashboard Cite

Background: Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging. Objectives: This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation. Methods: This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: one receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student’s T-tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05. Results: A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's t-test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA. Conclusions: The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, the 2 groups had no difference in the Numeric Rating Scale (NRS). Therefore, C3, C4, and C5 nerve blocks are a suitable RA method for middle clavicle fractures (20).…”

Section: Discussionmentioning

confidence: 99%

Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery

Mosaffa,

Ghasemi,

Habibi

et al. 2024

Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…ORIF of clavicular fractures is often performed under regional anesthesia with an interscalene block and an intermediate cervical plexus block. An RCT compared this with a C3, 4, and 5 nerve root block for midshaft and medial clavicular fractures 24 . More patients in the nerve root block group had a successful block, defined as not requiring general anesthesia (97% compared with 68%).…”

Section: Perioperative Pain Managementmentioning

confidence: 99%

What’s New in Orthopaedic Trauma

Chen,

Patterson

2024

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

The treatment of displaced proximal humeral fractures remains controversial. An updated systematic review and meta-analysis compared conservative treatment and surgical treatment (plating, nailing, or arthroplasty) of displaced fractures in adults ‡50 years of age 1 . Twenty-two trials (1,814 patients) were included, and no meaningful differences in clinical outcome or range of motion were identified. Complications were 3.3 times higher in the surgical treatment group. However, the study did not differentiate among 2-part, 3-part, or 4-part fractures. It also included both randomized controlled trials (RCTs) and comparative observational studies, which may have been impacted by a high risk of bias.Surgical treatment may be warranted in select populations. The lack of restoration of the medial column has been suggested to contribute to fixation failure. An RCT compared clinical and radiographic outcomes following locking plate fixation with (39 patients) or without (41 patients) a fibular allograft for proximal humeral fractures with medial column comminution 2 . There was no clinically important improvement in the Disabilities of the Arm, Shoulder and Hand (DASH) score or improvement in postoperative radiographs with addition of fibular allograft augmentation at 1 year.In certain fractures in the elderly population, reverse shoulder arthroplasty is chosen for definitive treatment. However, the ideal timing for a surgical procedure is unclear. A systematic review and meta-analysis compared outcomes following acute and delayed reverse shoulder arthroplasty ( ‡4 weeks after the injury) in patients ‡65 years of age 3 . Sixteen studies were included, and the overall complication rate was higher in the delayed group (18.5%) compared with the acute group (11.7%). Patients who underwent acute reverse shoulder arthroplasty also had better range-of-motion measurements as well as better American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. The results suggest that the surgical timing of arthroplasty for fracture treatment is important.High-grade injuries to the acromioclavicular joint may warrant fixation. Controversy remains with regard to the best type of fixation. A systematic review compared outcomes following suture button fixation (363 patients) and hook plate fixation (432 patients) for acute injuries (£21 days) 4 . Fourteen comparative studies were included, with suture Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I34).

show abstract

Contemporary methods of regional anesthesia in the surgical treatment of clavicle fractures: a narrative review

Adamenko,

Ezhevskaya

2024

Regional Anesthesia and Acute Pain Management

View full text Add to dashboard Cite

The problem of choosing a method of regional anesthesia for the surgical treatment of clavicle fractures is of great relevance due to a continued growth in possible contraindications for the choice of conventional methods of blocking the upper limb region. Chronic pulmonary dysfunction in patients after COVID-19, an increasing number of patients suffering from severe respiratory failure caused by chronic obstructive lung disease, and the features of injuries to the upper limb area that can impair lung function on the affected side have led to the conclusion that the use of regional anesthetics may pose more risks to patients than benefits. The authors searched for publications in various electronic databases and libraries, including PubMed, MEDLINE, and EMBASE and others. According to the results of the search, 904 literary sources were identified, and this review includes data from 26 studies containing information on 3391 patients who received one or another method of regional anesthesia and analgesia, and 29 other literary sources substantiating the relevance of the work. The review includes articles describing any methods of regional anesthesia used in surgical interventions on the collarbone in adults and children, as well as articles on complications and side effects of regional anesthesia methods used in clavicle surgery.The purpose of the review was to search for methods of regional anesthesia for patients in the surgical treatment of clavicle fractures, based on the analysis of modern literature. A review of the literature has allowed us to better understand the characteristics of traditional methods of regional anesthesia and to learn about new techniques that can improve patient comfort and safety during clavicular surgery.

show abstract

Could C3, 4, and 5 Nerve Root Block be a Better Alternative to Interscalene Block Plus Intermediate Cervical Plexus Block for Patients Undergoing Surgery for Midshaft and Medial Clavicle Fractures? A Randomized Controlled Trial

Cited by 3 publications

References 28 publications

Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery

Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery

What’s New in Orthopaedic Trauma

Contemporary methods of regional anesthesia in the surgical treatment of clavicle fractures: a narrative review

Contact Info

Product

Resources

About