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LETTERS TO EDITOR
Year : 2019  |  Volume : 13  |  Issue : 4  |  Page : 394-395

Ultrasound guided selective upper trunk block for clavicle surgery


Department of Anaesthesiology, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India

Correspondence Address:
Dr. Tuhin Mistry
First Floor, Old No. 94/95, New No. 51/14, Periyasubbanan 3rd Street, Opposite Shri Hari Hospital, Coimbatore - 641 011, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_134_19

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Date of Web Publication5-Sep-2019
 


How to cite this article:
Gurumoorthi P, Mistry T, Sonawane KB, Balasubramanian S. Ultrasound guided selective upper trunk block for clavicle surgery. Saudi J Anaesth 2019;13:394-5

How to cite this URL:
Gurumoorthi P, Mistry T, Sonawane KB, Balasubramanian S. Ultrasound guided selective upper trunk block for clavicle surgery. Saudi J Anaesth [serial online] 2019 [cited 2019 Nov 21];13:394-5. Available from: http://www.saudija.org/text.asp?2019/13/4/394/265988



Sir,

Various regional anaesthesia techniques have been described for pain management in clavicle fracture surgery. Superficial cervical plexus block alone or in combination with Interscalene Brachial Plexus Block, selective C5 nerve root block and selective supraclavicular nerve block have been reported in the literature.[1] We wish to describe a recent case where surgical fixation of the clavicle was performed solely under upper trunk blockade using a single point needle insertion.

A 25-year-old male patient presented for open reduction and internal fixation with plating of a displaced fracture of Lateral 1/3rd of the right clavicle. Ultrasound guided upper trunk block (selective C5 and C6 roots block of Brachial Plexus) was performed at interscalene groove with a 22-gauge, 50mm needle using an in-plane technique. About eight millilitres of 0.75% ropivacainewas injected - 4 ml between the prevertebral fascia and C5 root and 4 ml between C5 and C6 roots [Figure 1]. Within ten minutes of local anaesthetic deposition, the patient had lost cold sensation from the C3 to the C5dermatome of the anterior chest wall. Distal upper limb motor functions were intact and clinical signs of respiratory distress were not encountered. The surgery was performed in the beach chair position, the procedure lasted for 90 minutes. Intravenous paracetamol 1 gm, Dexamethasone 8 mg, and Ketorolac 30 mg were used as a part of multimodal analgesia. Oxygen was given via simple face mask and intravenous Dexmedetomidine infusion (0.7 mcg/kg/min) was used for conscious seadation during the surgery. The patient reported being comfortable throughout the surgery.
Figure 1: Schematic diagram of upper trunk block for clavicle surgery. Local anaesthetic spread is outlined by sky blue colour around C5 nerve root. SCM = Sternocleidomastoid Muscle, ASM = Anterior Scalene Muscle, MSM = Middle Scalene Muscle

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The innervations of the clavicle is complex and possibly from superficial cervical plexus (SCP) through terminal branches of suprascapularnerve and C5 nerve root.[2] It is mentioned in the literature that, injection of a large volume of local anaesthetic (LA) in Interscalene approach often blocks the cervical plexus.[3] With our ultrasound guided technique, a single point entry and two injections above and below the C5 root of brachial plexus is sufficient to cover the surgical area. There was no need for a separate SCP block probably because of cephalad spread of LA from C5 root level and blockade up to C3 area. Cadaveric studies, dye injection studies are needed to confirm the spread of LA and randomized controlled trial to establish its efficacy and safety over other described techniques.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shrestha BR, Sharma P. Regional anaesthesia in clavicle surgery. J Nepal Med Assoc 2017;56:265-7.  Back to cited text no. 1
    
2.
Shanthanna H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle. Indian J Anaesth 2014;58:327-9.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Singh SK. The cervical plexus: Anatomy and ultrasound guided blocks. Anaesth Pain Intensive Care 2015;19:323-32.  Back to cited text no. 3
    


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