Cervical Plexus Block Provides Postoperative Analgesia After Clavicle Surgery

To the Editor: We report a case of successful postoperative analgesia after clavicular open reduction and internal fixation (ORIF) using a cervical plexus block (CPB). While an interscalene block could provide analgesia, at the price of motor and sensory blockade of the upper extremity, using a CPB, to our knowledge, has not been described before. A healthy 49-year-old woman undergoing right clavicular ORIF was given preoperatively a deep (C2–C4) and superficial CPB according to the classic approach (1) using 0.5% bupivacaine. The surgical procedure was performed under general anesthesia. Following awakening from general anesthesia, the patient was pain-free until 14 hours postoperatively. She then took one dose of oral analgesics before discharge. The innervation of the clavicle and the overlying skin varies depending on the source in the literature between C3 and C6. Figure 1 summarizes the dermatome distributions published by several authors. The clavicle itself has been reported to be innervated either by C4, or by C5 and C6 (subclavian nerve).Figure 1.: Dermatome distributions determined by different methods: A, Foerster’s map, constructed using stimulation of nerve stumps and observing for vasodilatation (2). B, Head’s diagram, from observation of patients with herpes zoster lesions (3). C, Bonica’s map, developed “on the basis of personal observation and data published by others” (4). D, Keegan’s chart, established on the pattern of hypoalgesia following loss of a single nerve root (5).This case demonstrates that a cervical plexus block can provide analgesia after clavicle ORIF. It remains to be determined whether a CPB could be used as a sole anesthetic for clavicle ORIF in selected patients. Daniel S. Choi, MD, MBA Arthur Atchabahian, MD Anthony R. Brown, MD Department of Anesthesiology; Columbia University College of Physicians and Surgeons; New York, NY; [email protected]