Pereira Cândida Sofia, Ferros Catarina, Dinis Inês, Pereira Dulce, Miguel Diogo, Vico Manuel
Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal.
J Perioper Pract. 2024 Dec;34(12):375-377. doi: 10.1177/17504589241264408. Epub 2024 Jul 26.
Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis.
A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period.
Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.
区域麻醉在锁骨手术中可能是一种有吸引力的替代麻醉方法，但它需要对多条传递伤害性信息的颈神经和臂神经进行外周阻滞。颈深丛阻滞与椎旁神经阻滞一样，可能导致严重的副作用，如单侧膈肌麻痹。
一名66岁男性患者，美国麻醉医师协会身体状况分级为III级，在遭受高能创伤后计划行右锁骨切开复位钢板螺钉内固定术。麻醉前评估发现右侧血气胸和双侧肋骨骨折。我们决定实施区域麻醉（颈浅丛阻滞和锁胸筋膜平面阻滞），并联合右美托咪定输注，以避免有创机械通气并预防额外的肺部并发症。手术顺利完成，无需进一步麻醉。患者术后期间一直感觉舒适。
锁骨手术的区域麻醉具有促进非阿片类药物麻醉的优势。有效的疼痛控制可提高患者满意度并缩短住院时间。在我们的病例报告中，颈浅丛阻滞和锁胸筋膜平面阻滞联合应用是一种安全有效的区域麻醉方法。
