I have applied many cervical plexuses block for post operative analgesic effect, but awake clavicula surgery would be very advanced for me and my surgeon. :) very helpful video, thank you for your sharing.
Agree, we have clavicle fracture cases where the surgeons want to evaluate the brachial plexus afterwards and this is a great option for that. Thanks for watching!
Sorry if that wasn't clear...the probe is over the clavicle, with the shoulder to the left side of the screen. The patient's neck and head are in the upper right part of the screen, and the needle is being advanced from the caudal aspect. Hope that helps!
Usually we're combining this with a light general anesthetic with LMA in order to provide patient comfort and immobility, so it's usually just an analgesic block. I have done it sometimes for surgical anesthesia but as @igork7346 mentioned, it's useful to increase the concentration to hasten the onset and provide a denser block (e.g. 0.375% ropivacaine). I'll also do a quick cervical plexus block in order to make SURE that I've blocked the skin fibers over the clavicle. Thanks for watching!
I’ve used this technique for about a year now and absolutely love it. However, I am curious as to how long prior to incision do you perform the clavipectoral fascia block? I ask because I have noticed some patients do great during the case and even in phase 1 of pacu but the block seems to wear off quickly while others get the relief I’d expect 18 to 24 hours.
Hello! In my practise combinate this block with cervical plexus block. 10-15 minutes after block may get surgery (lidocaine 1% + ropivacaine 0.375%). I think only ropivacaine solution will need a little bit more time before surgery.
Glad it's working well for you! I usually use a dilute solution of ropivacaine (0.2%) with epinephrine (2.5 mcg/ml) and dexamethasone (2 mg)--that combo typically provides 16-24 hrs of coverage. Hope that helps!
