Comparative study on the efficacy of ultrasound guided clavipectoral fascial plane block versus interscalene brachial plexus block combined with superficial cervical plexus block in clavicle surgeries- a randomized clinical trial

Abstract

AIMS AND OBJECTIVES AIM: This study aims to compare the Efficacy Of ultrasound-guided clavipectoral Fascial Plane Block versus Interscalene Brachial Plexus Block Combined With Superficial Cervical Plexus Block Posted For Clavicle Surgery PRIMARY OBJECTIVES: • To assess the success rate of the block • Ultrasonographic assessment of hemi diaphragmatic paresis by using sigh test • Modified Bromage scale to assess the upper limb function SECONDARY OBJECTIVES: • Assessment of pain by using the VAS score • Time for the first rescue analgesia • Look for side effects, including local anaesthetic systemic toxicity and Horner syndrome METHODS: A Total of 60 patients with unilateral clavicle fractures of ASA I & II, age between 18 to 55 who underwent elective internal fixation of clavicle fractures in our hospital, willing for proposed blocks were included in this study. Randomization was done by a computer-generated randomized table Group C: Superficial Cervical Plexus Block and Clavipectoral Fascial Plane Block (S.C.P.B. and C.P.B.) in 30 patients Group I: Superficial Cervical Plexus Block and Interscalene Brachial Plexus Block (S.C.P.B. and I.S.B.P.) in 30 patients 10 Docusign Envelope ID: D8185B3F-E09C-4406-9E88-92889FB5AACA After informed consent, the blocks were given as per the standard protocol by the same anaesthetist under ultrasound guidance. Group C (SCPB AND CPB): Group I (SCPB AND ISBP): S.C.P.B. with 7ml of 0.5% Ropivacaine C.P.B. with 20ml of 0.5% Ropivacaine S.C.P.B. with 7ml of 0.5% Ropivacaine I.S.B.P. with 20ml of 0.5% Ropivacaine At the beginning of the surgery, all patients were administered 0.05 mg/kg of midazolam. The primary objectives were measured as the effect of the block was obsseved at 30 min in three areas: the sternoclavicular joint, mid-clavicle and acromioclavicular joint, Modified Bromage scale (M.B.S.) to assess upper limb movement function and Visual Analog Score(VAS). The diaphragmatic movement was evaluated by real-time M mode using ultrasonography of the hemidiaphragm, and adverse reactions like local anaesthetic systemic toxicity, pneumothorax and haemothorax were also noted. RESULTS: The study compared the Clavipectoral Fascial Plane Block with Superficial Cervical Plexus Block (Group C) and the Interscalene Brachial Plexus Block with the Superficial Cervical Plexus Block (Group I) across multiple parameters. Both groups were demographically similar in age (32.83 ± 10.77 vs. 34.57 ± 9.58 years, p = 0.347) and height (1.673±0.053m vs. 1.684 ± 0.043m , p = 0.382), but Group C had a significantly higher weight (76.53 ± 6.12 vs. 69.80 ± 7.34 kg, p = 0.00005) and BMI (27.33 ± 1.28 vs. 24.67 ± 2.84, p = 0.00003). Analgesic outcomes favoured Group C, with a longer duration of analgesia (23.23 ± 1.96 vs. 14.23 ± 1.33 hours, p < 0.001) and lower VAS pain scores at 6 hours (0.00 ± 11 Docusign Envelope ID: D8185B3F-E09C-4406-9E88-92889FB5AACA 0.00 vs. 0.87 ± 0.97, p < 0.001), 12 hours (0.87 ± 1.01 vs. 2.80 ± 0.61, p < 0.001), and 24 hours (2.93 ± 0.94 vs. 6.63 ± 0.81, p < 0.001), demonstrating superior and prolonged pain relief. Respiratory function was better preserved in Group C, as diaphragmatic excursion at 30 minutes was significantly greater (5.79 ± 0.52 vs. 2.96 ± 0.60 cm, p < 0.001), with a lower percentage decrease (95.57%±4.25 vs. 50.21% ± 10.60, p < 0.001), suggesting reduced risk of respiratory impairment in Group C. Sensory blockade was effective in both groups, with no significant differences in block success scores across the sternoclavicular (2.77 ± 0.43 vs2.60 ± 0.50 ,p = 0.171) , midclavicular (3.00 ± 00 vs. 2.90 ± 0.31, p = 0.083), and acromioclavicular (2.93 ± 0.25 vs. 2.87 ± 0.35, p = 0.398) regions. However, Group I resulted in significant motor blockade (MBS 2.47 ± 0.57 vs. 0.00 ± 0.00, p < 0.001), whereas Group C preserved motor function. Additionally, Group I was associated with hemidiaphragmatic paresis (13%)and Horner syndrome (2%), complications that were absent in Group C. CONCLUSION: The results indicate that Clavipectoral Fascial Plane Block had superior analgesic efficacy, with a significantly longer duration of pain relief and lower VAS scores at all time points compared to the Interscalene Brachial Plexus Block combined with Superficial Cervical Plexus Block Additionally, Clavipectoral Fascial Block was associated with no incidence of hemi diaphragmatic paresis or Horner syndrome, making it a safer alternative for patients at risk of respiratory complications.