Fractures of the collarbone, or clavicle, constitute nearly 3% of all fractures in adults 1. Primarily affecting young males, directly falling on the shoulder is the most frequent injury mechanism for a collarbone fracture. These fractures are often sustained in the context of sports or car accidents. A broken collarbone is relatively less likely to result in surgery, however, anesthesia may still be needed to ensure patient comfort.
Clavicle fracture repair surgery has historically been performed with patients under general anesthesia. In recent years however, the combination of various regional anesthetic blocks has been found to provide adequate anesthesia for surgery for a broken collarbone, with the added benefit of providing postoperative analgesia 2.
The use of regional anesthesia requires an understanding of the nerves responsible for sensation in the target area. The sensorineural innervation of the clavicle, while complex, is considered to involve both the cervical plexus and brachial plexus. Peripheral nerve blocks used to anesthetize the clavicle thus tend to include cervical plexus blocks, brachial plexus blocks, or combined cervical and brachial plexus blocks 3.
Indeed, research has demonstrated that regional anesthesia using combined modified superficial cervical and brachial plexus blocks represents a reliable, efficient technique for a broken collarbone. In addition, research has also shown that ultrasound-guided combined interscalene and superficial cervical plexus blocks may also work well as an option for anesthesia management during clavicle fracture surgery. Furthermore, ultrasound guidance has been found to specifically improve the success rate of regional anesthesia.
In the end, combined regional anesthesia blocks are particularly beneficial for patients for whom general anesthesia is high risk but who need surgery for their broken collarbone. In addition, a recent comprehensive literature search has found that patients with regional anesthesia have a more significant pain-free period and less intraoperative and postoperative opioid consumption than patients with general anesthesia 3. However, further studies remain to be carried out on best protocols.
The wide-awake local anesthesia no tourniquet (WALANT) technique has been implemented in the context of many different types of orthopedic surgeries 4. This technique is beneficial in that it circumvents the adverse effects of general anesthesia and reduces the overall cost of surgery. In addition, in some patients with high morbidity and other risk factors for whom other anesthesia is risky, the WALANT technique can be an effective alternative. One case report found that clavicular fixation or similar operations following a broken collarbone could be successfully carried out without any complication using the WALANT technique 4.
The use of regional anesthesia for a broken collarbone has garnered much clinical attention lately for its demonstrated safety and efficacy. However, additional research remains to be carried out in order to further elucidate the best protocols for administering anesthesia for a broken collarbone.
References
1. Postacchini, F., Gumina, S., De Santis, P. & Albo, F. Epidemiology of clavicle fractures. J. Shoulder Elb. Surg. (2002). doi:10.1067/mse.2002.126613
2. Ryan, D. J., Iofin, N., Furgiuele, D., Johnson, J. & Egol, K. Regional anesthesia for clavicle fracture surgery is safe and effective. J. Shoulder Elb. Surg. 30, e356–e360 (2021). doi: 10.1016/j.jse.2020.10.009.
3. Ding, X. Regional Anesthesia for Clavicle Fracture Surgery-What is the Current Evidence: A Systematic Review. Open Anesth. J. 16, (2022). DOI: 10.2174/25896458-v16-e2208010
4. Niempoog, S., Tanariyakul, Y. & Jaroenporn, W. Wide-awake local anesthesia for clavicle fracture fixation: A case report. Int. J. Surg. Case Rep. 79, 112 (2021). doi: 10.1016/j.ijscr.2021.01.005.