Selective blockade of supraclavicular nerves and upper trunk of brachial plexus “The SCUT block” towards a site-specific regional anaesthesia strategy for clavicle surgeries - A descriptive study

Abstract

Background and Aims: Commonly, the superficial cervical plexus and interscalene block were combined to provide surgical anaesthesia for procedures on the clavicle, which are neither selective nor site-specific considering the innervation of the clavicle. The aim was to analyse effectiveness and block dynamics of selectively blocking supraclavicular (SC) nerves and upper trunk (UT) of brachial plexus (SCUT BLOCK) as a site-specific regional anaesthesia strategy for clavicle surgery. Methods: SC nerves and UT were blocked with 3-ml and 5-ml local anaesthetic, respectively, in 70 American Society of Anesthesiologists I and II patients aged above 18 years, undergoing clavicle surgery. Sensory-motor conduction blockade was assessed in both the plexus territories, following which surgery ensued. Number of patients who exhibited complete conduction blockade of the targeted nerves, number of surgeries completed under the block, intraoperative rescue analgesics, duration of postoperative analgesia and complications were recorded. Results: Sensory and motor mapping showed complete conduction blockade of the targeted nerves in all patients, all other branches were spared. The surgery was completed exclusively under block in 67 (Strategy success rate 96%) out of 70 patients. Intraoperatively, two patients required supplementation of block with a local infiltration and general anaesthesia was administered for one patient. The mean duration of postoperative analgesia was 5 (1.2) hours [mean (standard deviation)]. Only one patient developed ptosis; no other complications were noted. Conclusions: “The SCUT block” is an effective site-specific regional anaesthesia strategy for clavicle surgery.

The Effects of Anesthesia Methods on the Prognosis of Elderly Patients Undergoing Upper Limb Surgery: A Systematic Review

“…Supraclavicular and interscalene blocks are advanced anesthesia techniques. The former targets the brachial plexus proximally, providing dense, reliable anesthesia for the upper limb with minimal phrenic nerve risk but a slight pneumothorax risk (45). The latter targets the brachial plexus distally, offering excellent analgesia for shoulder and arm surgery with less respiratory risk but potential for transient hemi-diaphragmatic paresis in older patients, requiring careful monitoring and consideration of contraindications.…”

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

“…Although the high-volume ISB often blocks the cervical plexus [35], combinations of RA techniques are recommended to avoid complications. Such combinations include ultrasound-guided ISB + SCPB [36], superior trunk block + SCPB [37], or SCUT (selective supraclavicular + upper trunk) block [38]. Sivashanmugam et al considered the SCUT block as an effective site-specific RA strategy for clavicle surgery in their study on 70 patients [38].…”

“…Such combinations include ultrasound-guided ISB + SCPB [36], superior trunk block + SCPB [37], or SCUT (selective supraclavicular + upper trunk) block [38]. Sivashanmugam et al considered the SCUT block as an effective site-specific RA strategy for clavicle surgery in their study on 70 patients [38]. Plexus blocks like ISB or SCPB can cause hemidiaphragmatic paresis due to associated blockade of the phrenic nerve that can cause detrimental effects in some patients with obstructive sleep apnea, obesity, or significant underlying lung disease [14].…”

Awake clavipectoral facial plane block for clavicle surgeries: A case series

“…T Sivashanmugam et al . [ 8 ] reported the advantages of selective blockade of supraclavicular nerves and upper trunk of brachial plexus, ‘The SCUT block’, towards a site-specific regional anaesthesia strategy for clavicle surgeries.…”