Clavipectoral fascia plane block for analgesia after clavicle surgery

Abstract

Clavicular fracture is the most common injury of the shoulder girdle, and has an incidence of 35%. It mainly occurs in young men, usually as a result of sports activities or traffic accidents, and the most common fracture occurs in the middle third or diaphysis of the clavicle. Although most such diaphyseal fractures can be treated non-surgically, there is growing evidence that better functional outcomes are achieved with surgical treatment. Pain management, therefore, after clavicular fracture or surgery is very important. Since initial post-fracture pain may not respond to opioids, peripheral nerve blocks may be a useful complement to oral medication. A thorough understanding of the sensory innervation of the peripheral nerve is essential to achieve good analgesia following clavicular fracture or surgery. This innervation is complex, and the supraclavicular, subclavian, long thoracic/suprascapular nerves, alone or together, may be responsible for pain transmission after clavicular fracture and surgery. Superficial cervical plexus block, interscalene block, and combined superficial cervical plexus-interscalene block can be used to anaesthetise the clavicle. The superficial cervical block can also be combined with the clavipectoral fascia plane block. The clavipectoral fascia is a thick fascia located on the clavicular portion of the pectoralis major muscle that extends superior, medial and superolateral from the clavicle, the costochondral joints, and the coracoid process, respectively. It suspends the floor of the axilla and protects the neurovascular structure, occupying the space between the clavicle and the pectoralis minor muscle. The clavipectoral fascia completely surrounds the clavicle, and the nerve endings of the clavicle penetrate this fascia.