Comment: Awake clavipectoral fascial plane block for clavicle surgeries: A case series

Dear Editor, I am keenly interested in Natrajan et al.'s[1] case series highlighting the significance of clavipectoral fascial plane block (CFPB), especially in mid-shaft clavicle fractures. It needs to be clarified that in addition to CFPB, preplanned or rescue blocks were performed in four of the eight cases. This signifies that CFPB may not be singularly effective for clavicle surgeries. Evidence suggests that clavicle innervation is complex and extensive and highlights the limitations of CFPB alone for clavicle surgeries.[2-5] The dermatomal coverage provided by the supraclavicular nerves will be missed while doing a CFPB, which predominantly blocks the osteotomes, and hence, a separate block or at least a transverse skin infiltration traversing the length of the clavicle is necessary. The direction of the needle advancement and the exact site of drug deposition for CFPB block need to be clarified further for a better understanding. Also, the authors' two-point injection described and the effective concentration of local anaesthetic (0.125% bupivacaine and 0.5% lignocaine) may not suffice to achieve complete anaesthesia.[2,3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.