Human Anatomy and Embryology Unit, Universitat de Barcelona Facultat de Medicina i Ciències de la Salut, Barcelona, Catalunya, Spain.
Anesthesia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Reg Anesth Pain Med. 2024 May 7;49(5):368-372. doi: 10.1136/rapm-2023-104785.
The clavipectoral fascia plane block (CPB) is a novel anesthetic management strategy proposed by Valdes-Vilches for clavicle fractures. This study aimed to investigate the distribution of the injected solution around the clavicle and the surrounding tissues.
Twelve clavicle samples were acquired from six cadavers. CPB was conducted using a 20 mL solution comprising methylene blue and iodinated contrast agent to improve visibility of the injected substance's dispersion. Methylene blue spread was assessed through anatomical dissection across distinct planes (subcutaneous, superficial muscular, deep muscular, and periosteal layers of the clavicle) in five cadavers. For the purpose of comparing methylene blue distribution, CT scans were performed on three cadavers.
Methylene blue was detected in the medial, intermediate, and lateral supraclavicular nerves, as well as superficial muscles including the deltoid, trapezius, sternocleidomastoid, and pectoralis major. However, no staining was observed in the deep muscle plane, including the subclavius, pectoralis minor, and clavipectoral fascia (CPF). Anterosuperior periosteum exhibited staining in 54% of surface, while only 4% of the posteroinferior surface. CT images displayed contrast staining in anterosuperior periclavicular region, consistent with observations from sagittal sections and anatomical dissections.
The CPB effectively distributes the administered solution in the anterosuperior region of the clavicular periosteum, superficial muscular plane, and supraclavicular nerves. However, it does not affect the posteroinferior region of the clavicular periosteum or the deep muscular plane, including the CPF.
锁骨骨折的新型麻醉管理策略——肩胛锁骨间隙平面阻滞（CPB）由 Valdes-Vilches 提出。本研究旨在探讨注射溶液在锁骨及其周围组织中的分布情况。
从 6 具尸体中采集 12 个锁骨样本。CPB 采用 20 mL 包含亚甲蓝和碘造影剂的溶液进行，以提高注射物质弥散的可视性。在 5 具尸体的不同平面（锁骨皮下、浅肌、深肌和骨膜层）进行解剖学解剖以评估亚甲蓝的扩散。为了比较亚甲蓝的分布，对 3 具尸体进行了 CT 扫描。
亚甲蓝在锁骨内侧、中间和外侧的锁骨上神经以及三角肌、斜方肌、胸锁乳突肌和胸大肌等浅表肌肉中均有检出。然而，在深肌平面（包括锁骨下肌、胸小肌和肩胛胸筋膜）中未观察到染色。前上骨膜有 54%的表面呈现染色，而后下骨膜仅有 4%的表面呈现染色。CT 图像显示前上肋锁区有对比染色，与矢状切片和解剖学解剖的观察结果一致。
CPB 可有效地将注射溶液分布在锁骨骨膜的前上区域、浅表肌肉平面和锁骨上神经。然而，它不会影响锁骨骨膜的后下区域或深肌平面，包括肩胛胸筋膜。
