Letters to the Editor: Letters & Announcements
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).
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@example.com
1. Adriani J. Blocking of spinal nerves. In: Adriani J, ed. Labat’s Regional anesthesia: techniques and clinical applications. St. Louis: Warren H. Green, 1985:236–54.
2. Foerster O. The dermatomes in man. Brain 1933;56:1–39.
3. Head H, Campbell AW. The pathology of herpes zoster and its bearing on sensory localization. Brain 1900;23:353–523.
4. Bonica JJ. Applied anatomy relevant to pain. In: Bonica JJ, ed. Management of pain. 2nd ed. Malvern: Lea & Febiger, 1990:133–58.
5. Keegan JJ, Garrett FD. The segmental distribution of the cutaneous nerves in the limbs of man. Anat Rec 1948;102:409–37.