Faculty Bibliography

BACKGROUND:Historically, clavicle fracture repairs have been performed under general anesthesia. However, in the last few years, the combination of an interscalene brachial plexus block and a modified superficial cervical plexus block has been described to provide adequate anesthesia for clavicle fracture surgery, with the added benefit of postoperative analgesia. Members of our anesthesiology department began utilizing this block with sedation for a subset of patients undergoing clavicle fracture fixation in March, 2013. METHODS:This study is a retrospective review of patients who underwent clavicle fracture repair at a single institution between June, 2014 and November, 2017. The decision for type of anesthesia (regional vs. general) was made jointly by the patient, anesthesiologist, and surgeon. Demographic data, relevant perioperative times, and intraoperative pain medication consumption were recorded, and comparisons were made in these variables between the regional and general groups. RESULTS:A total of 110 patients with 110 fractures were included. Fifty-two patients received regional anesthesia only with the combined block, while 58 patients received general anesthesia with an interscalene brachial plexus block. There were no major anesthetic-related complications noted in any patients, and there were no cases in which regional anesthesia had to be converted to general anesthesia because of block failure. Anesthesia start time was significantly longer in the general anesthesia group (29 vs. 20 minutes, p=0.022), as was total case time (164 vs. 131 minutes, p<0.001). Patients in the general group required significantly more intraoperative fentanyl administration (207 vs. 141 mcg, p=0.002). CONCLUSION/CONCLUSIONS:Regional anesthesia using a combined brachial plexus and modified superficial cervical plexus is a reliable, efficacious technique. The combined block appears to be a reasonable alternative to general anesthesia with interscalene brachial plexus block, and may have benefits with regards to anesthesia start time and total case time. LEVEL OF EVIDENCE/METHODS:Level III; Retrospective Cohort Comparison; Treatment Study.