Response to the comments on our published article: Awake clavipectoral fascial plane block for clavicle surgeries: A case series

Dear Editor, In response to the queries raised by one of the readers[1] on our published article,[2] we would like to address the queries one by one. A sole clavipectoral fascial plane block (CPFB) was not employed in all the cases; pre-planned or rescue blocks were performed in four of the eight cases. As mentioned, various supplementary blocks were performed based on the fracture site.[1] Regarding the direction of the needle insertion, we acknowledge the discrepancy between the text and the figure. In our cases, we practised both cranial-to-caudal and caudal-to-cranial needle insertion, depending on the side of the clavicle. The key point here is the precise deposition of the pharmacological agent within the space between the clavicle's periosteum and fascia facilitated by ultrasound guidance. Similarly, there is ambiguity about drug deposition. We would like to clarify that the drug needs to be deposited between the clavipectoral fascia and the clavicle. In ultrasound, the drug deposition during injection is seen above the clavicle, but eventually, the drug spreads all around the clavicle. In addition, we want to clarify that we mixed 5 mL of 0.5% bupivacaine and 5 mL of 2% lignocaine, and the effective concentration was 0.25% bupivacaine and 1% lignocaine. This concentration was effective in producing complete anaesthesia in all our cases. We agree with the reader that CFPB should be used cautiously, particularly as a sole anaesthetic technique. Randomised controlled trials with adequate sample size are the next step forward in studying the effectiveness of this block in clavicle surgeries. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.