Triple Regional Block for Clavicle Surgery in a Pregnancy: A Combination of Interscalene, Superficial Cervical Plexus, and Clavipectoral Fascial Plane Blocks
DOI:
https://doi.org/10.22146/jka.v13i3.31457Keywords:
Clavipectoral fascial plane block, clavicle surgery, interscalene block, superficial cervical plexus block, pregnancyAbstract
Background: Clavicle surgery is commonly performed under general anesthesia; however, this approach may pose additional risks in pregnant patients because of physiological airway changes and potential fetal exposure to anesthetic agents. Regional anesthesia may offer a safer alternative in selected cases.
Case: A 32-year-old woman at 28 weeks and 5 days of gestation presented with a closed midshaft fracture of the left clavicle following a motorcycle accident. Radiographic evaluation confirmed a comminuted midshaft clavicle fracture (Allman type I). The patient underwent open reduction and internal fixation under ultrasound- and nerve stimulator-guided triple regional anesthesia consisting of an interscalene block with 25 mL of 0.5% bupivacaine, a superficial cervical plexus block with 5 mL of 0.5% bupivacaine, and a clavipectoral fascial plane block with 5 mL of 2% lidocaine. Adequate surgical anesthesia was achieved with stable maternal hemodynamics and fetal heart rate, without conversion to general anesthesia.
Discussion: Clavicle surgery presents a challenge for regional anesthesia because of its complex innervation from both the cervical and brachial plexuses. In this pregnant patient, combining interscalene, superficial cervical plexus, and clavipectoral fascial plane block provided complementary sensory coverage and adequate surgical anesthesia without additional sedation or conversion to general anesthesia. This approach minimized airway manipulation and systemic anesthetic exposure, which are important.
considerations during pregnancy, while maintaining stable maternal hemodynamics and fetal heart rate throughout the procedure.
Conclusion: This case demonstrates that a triple regional block technique can provide adequate surgical anesthesia for clavicle fixation in pregnancy, with stable maternal and fetal well-being
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