Regional Anesthesia for Pain Control in Clavicle Surgery

Background:
Regional anesthesia (RA) is standard of care in many orthopedic operations and the indications to its use are increasing and constantly being studied. In the case of clavicle surgery, the role and technique of RA is controversial due to complex innervation of the clavicle and the relatively moderate pain level of clavicle surgeries.

Methods:
All adult patients who underwent open reduction and internal fixation (ORIF) for acute Clavicle fracture as a single procedure between the years 2013-2020 were studied. Demographic and medical data (age, sex, BMI, ASA score), method of anesthesia and early post-operative outcomes were collected. Pain levels, perioperative opioid use and total OR time were compared between patients treated with general anesthesia (GA) alone and patients treated with GA+ interscalene brachial plexus nerve block (ISB).

Results:
Sixty seven patients treated with GA+ISB and 306 patients treated with GA alone were included. There were no significant differences between the groups in age, sex, ASA score and BMI. Pain levels in the GA+ISB group were significantly lower than in the GA group (1.12 vs 2.45 on admission to PACU, p<0.001, 0.43 vs 0.98 at PACU discharge, P

Conclusions:
The use of ISB in addition to GA during clavicle fracture surgery is associated with lower early post-operative pain levels and lower levels of opioid administration but increase the total time spent in the OR by 25 minutes. The authors conclude that if general anesthesia is to be performed, the addition of RA, and specifically ISB, has a limited short term benefit to the patient and it exposes the patient to unnecessary risks, increases OR time and may increase costs.