Analgesic quality and safety of selective supraclavicular nerves and C5 root blockade in clavicle surgery - A randomized controlled trial

Background: Clavicle fractures and acromioclavicular (AC) joint dislocations are common in athletic adults. Although peripheral nerve blocks are widely used in upper extremity surgery, their role in clavicle surgery remains debated due to the complex innervation. This study assessed whether selective blockade of the supraclavicular nerves and C5 root is a suitable technique for improving postoperative pain management. Methods:In this randomized trial (German Clinical Trial Registry DRKS ID: DRKS00017286), 56 patients undergoing clavicle or AC joint surgery were allocated to three groups. The first group received general anesthesia with a combined nerve block of the supraclavicular nerves and C5 root (NSCL+C5), the second received general anesthesia only with C5 root block (C5), and the third had general anesthesia with systemic analgesia (control group). Pain levels (NRS) and piritramide consumption were the primary endpoints, while secondary endpoints included diaphragmatic excursion and oxygen saturation to assess phrenic nerve palsy. Results: Patients in the NSCL+C5 group reported no pain during the first postoperative hour (NRS t0-t1=0), significantly less than the C5 (NRS t0=1.9 plus-or-minus sign 1.4, P=0.001) and control group (NRS t0=4.5 plus-or-minus sign 2.2, P<0.001). No additional opioid was required, which was significantly lower compared with 4.4 mg plus-or-minus sign 5.3 (P=0.01) in the C5 group and 12.6 mg plus-or-minus sign 5.3 (P<0.001) in the control group. Phrenic nerve palsy was more frequent in the NSCL+C5 group, without affecting oxygen saturation. Conclusion: Combined blockade of the supraclavicular nerves and C5 root significantly reduces postoperative pain and opioid consumption in clavicle surgery. Despite a higher rate of phrenic palsy, respiratory function remained unaffected.