Successful using of combined interscalene block and deep cervical plexus block for clavicle fracture in patients with impaired airway integrity due to combat injury

Ergun Mendes 1 * , Aziz Yarbil 1, Ali Bestami Kepekci 2, Oya Yalcin Cok 3
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1 Anesthesiology and Reanimation Department, Kilis State Hospital, Kilis, Turkey
2 Department of Anesthesia, Health Services Vocational High School, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
3 Department of Anesthesiology, School of Medicine, Baskent University, Adana, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 4, pp. 95-98.
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General anaesthesia has a priority in surgical interventions of clavicle; however, regional techniques may come to the fore in the presence of increased risk factors. The innervation of the clavicle region is very complex and has not been fully described; therefore, only a limited number of different regional anaesthesia approaches should be considered. Here, we present the management of a clavicle fracture with a combination of an interscalene block (ISB) and deep cervical plexus block (dCPB) in a patient with severe maxillo-facial trauma (MFT) and diaphragmatic hernia due to combat injury. A 35-year-old male admitted to the emergency room as a war-wounded patient had suffered MFT and an unstable clavicle defect during the Syrian War. A diaphragmatic hernia was also detected during examination. The patient underwent operation with regional anaesthesia of the clavicle under spontaneous respiration. With standard monitoring and sedation, ISB and dCPB were performed under ultrasound guidance with a mixture of 0.25% bupivacaine (20 mL) and 0.5% lidocaine (10 mL). In the perioperative period, the patient's vital signs remained stable. The patient had no pain during the surgery. We suggest that the combination of ISB and dCPB is an efficient option for management of clavicle fracture in patients with multiple comorbidities.


Mendes E, Yarbil A, Kepekci AB, Yalcin Cok O. Successful using of combined interscalene block and deep cervical plexus block for clavicle fracture in patients with impaired airway integrity due to combat injury. J CLIN MED KAZ. 2021;18(4):95-8.


  • 1. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452-456.
  • 2. Schuitemaker RJ, Sala-Blanch X, Rodriguez-Perez CL, Mayoral RJ, Lopez-Pantaleon LA, Sanchez-Cohen AP. The PECS II block as a major analgesic component for clavicle operations: A description of 7 case reports. Rev Esp Anestesiol Reanim. 2018;65(1):53-58.
  • 3. Sanllorente-Sebastian R, Wilk P, Garces-Perez GM, Arias-Rodriguez L, Andres-Pedrosa M, Martinez-Ibeas E. Awake clavicle surgery with PECS1 and ultrasound selective supraclavicular nerve block combination. J Clin Anesth. 2020;66:109937.
  • 4. Althausen PL, Shannon S, Lu M, O'Mara TJ, Bray TJ. Clinical and financial comparison of operative and nonoperative treatment of displaced clavicle fractures. J Shoulder Elbow Surg. 2013;22(5):608-611.
  • 5. Tran DQ, Tiyaprasertkul W, Gonzalez AP. Analgesia for clavicular fracture and surgery: a call for evidence. Reg Anesth Pain Med. 2013;38(6):539-543.
  • 6. Balaban O, Dulgeroglu TC, Aydin T. Ultrasound-Guided Combined Interscalene-Cervical Plexus Block for Surgical Anesthesia in Clavicular Fractures: A Retrospective Observational Study. Anesthesiol Res Pract. 2018;2018:7842128.
  • 7. Shrestha BR, Sharma P. Regional Anaesthesia in Clavicle Surgery. JNMA J Nepal Med Assoc. 2017;56(206):265-267.
  • 8. Vandepitte C, Latmore M, O'Murchu E, Hadzic A, Van de Velde M, Nijs S. Combined interscalene-superficial cervical plexus blocks for surgical repair of a clavicular fracture in a 15-week pregnant woman. Int J Obstet Anesth. 2014;23(2):194-195.
  • 9. Ryan DJ, Iofin N, Furgiuele D, Johnson J, Egol K. Regional anesthesia for clavicle fracture surgery is safe and effective. J Shoulder Elbow Surg. 2020;30(7):e356-360.
  • 10. Arjun BK, Vinod CN, Puneeth J, Narendrababu MC. Ultrasound-guided interscalene block combined with intermediate or superficial cervical plexus block for clavicle surgery: A randomised double blind study. Eur J Anaesthesiol. 2020;37(11):979-983.
  • 11. Brull R MC, Sawyer RJ, von Schroeder HP. The indications and applications of interscalene brachial plexus block for surgery about the shoulder. Acute Pain. 2004;6:57–77.
  • 12. Shanthanna H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle. Indian J Anaesth. 2014;58(3):327-329.
  • 13. Kline JP. Ultrasound-guided placement of combined superficial cervical plexus and selective C5 nerve root catheters: a novel approach to treating distal clavicle surgical pain. AANA J. 2013;81(1):19-22.
  • 14. Salvadores de Arzuaga CI, Naya Sieiro JM, Salmeron Zafra O, Gonzalez Posada MA, Marquez Martinez E. Selective Low-Volume Nerve Block for the Open Surgical Fixation of a Midshaft Clavicle Fracture in a Conscious High-Risk Patient: A Case Report. A A Case Rep. 2017;8(11):304-306.
  • 15. Verelst P, van Zundert A. Respiratory impact of analgesic strategies for shoulder surgery. Reg Anesth Pain Med. 2013;38(1):50-53.
  • 16. Dirzu DS. Hemidiaphragmatic paresis versus block failure: the effect of anesthetic volume reduction for supraclavicular plexus block. Reg Anesth Pain Med. 2019;44:761-762.