Wide-awake local anesthesia for clavicle fracture fixation: A case report

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

“…Following a thorough review of the titles, abstracts, full-text, and reference lists, we included and extracted data from a total of 44 studies and/or reports containing patient data, spanning a total of 3161 patients with clavicular fractures who received some form of regional anesthesia and analgesia. We excluded one retracted article and its retraction note from the final list of 44 studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 5 RCTs, 5 prospective observational studies, 5 retrospective observational studies, and 29 case reports/case series included in this scoping review ( Figure 1 and Table 2 ).…”

“…Lastly, awake clavicle fracture fixation surgery under tumescent local anesthesia (LA) alone has also been described in a case report, as well as in a case series [ 22 , 27 ].…”

“…This technique utilizes a tumescent injection of lignocaine and adrenaline to provide both LA and vasoconstriction. Subcutaneous infiltration produces nociceptive blockade, and subperiosteal infiltration has been thought to facilitate LA spread via nutrient or transcortical vessels from the periosteum into the endosteal circulation, thus, blocking sensory fibers in the periosteum, mineralized bone, and bone marrow [ 22 , 27 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ].…”

“…Two reports [ 22 , 27 ] demonstrated the potential of local infiltration as a viable anesthetic technique ( Supplementary Table S2 ). Niempoog et al used 50 mL 1% lignocaine with adrenaline and sodium bicarbonate for clavicle fracture fixation with no intraoperative pain and no reported complications [ 22 ].…”

“…Two reports [ 22 , 27 ] demonstrated the potential of local infiltration as a viable anesthetic technique ( Supplementary Table S2 ). Niempoog et al used 50 mL 1% lignocaine with adrenaline and sodium bicarbonate for clavicle fracture fixation with no intraoperative pain and no reported complications [ 22 ]. A series of 16 cases was also reported by Ahmad et al [ 27 ] who successfully used 40 mL 1% lignocaine with adrenaline in patients without sedation or conversion to GA. Only two patients had mild pain (2/10) during reduction.…”