Selective C5 nerve root block versus combined interscalene block for clavicle surgery

Year 2022, Volume: 8 Issue: 4, 434 - 441, 04.07.2022

Eralp Çevikkalp , Furkan Yapici

https://doi.org/10.18621/eurj.881498

Abstract

Objectives: The pain sensation of the clavicle is innervated by two separate plexuses. Regional anesthesia techniques for this area are challenging and complicated. Interscalene block, superficial cervical block, or a combination of these two is commonly used for regional anesthesia in clavicle surgery. The aim of this study was to investigate the efficacy of C5 nerve root block for clavicle surgery.

Methods: Patients were divided into two groups: Group C5B (patients who received C5 nerve root block + superficial cervical plexus block) and Group ISB (patients who received interscalene block + superficial cervical plexus block). Motor block was assessed by the Medical Research Council Scale for Muscle Strength, while the sensory block of the areas corresponding to the nerve trace was assessed using the pinprick and cold testing. Furthermore, ultrasound was employed to evaluate phrenic nerve paralysis.

Results: There was no difference between the groups in terms of mean age. The mean age of Group ISB was higher; however, the comparison of comorbidities revealed no significant difference between the groups. This statistically significant difference was clinically insignificant. Group C5B had lower 6-hour pain at rest, lower 0, 2, 4-hour pain on movement, and less postoperative analgesic consumption. Moreover, the time to first analgesic requirement was significantly longer in Group C5B. The motor examination of the peripheral nerves showed a significant difference in Group C5B.

Conclusions: We are of the opinion that C5 nerve root block can be used instead of interscalene block since it does not produce a motor block in hand movements and preserves diaphragmatic functions. C5 nerve root block may therefore be considered an alternative to conventional interscalene block for clavicle surgery.

Keywords

ultrasound, selective nerve root block, interscalene block, superficial cervical block, clavicle surgery

References

• 1. DeFroda SF, Lemme N, Kleiner J, Gil J, Owens BD. Incidence and mechanism of injury of clavicle fractures in the NEISS database: athletic and non athletic injuries. J Clin Orthop Trauma 2019;10:954-8.
• 2. Huttunen TT, Kannus P, Lepola V, Pihlajamäki H, Mattila VM. Surgical treatment of clavicular fractures in Finland - A register based study between 1987 and 2010. Injury 2013;44:1899-903.
• 3. Moore K, Dalley AF, Agur AM. Clinically Oriented Anatomy, 7th ed. Balimore, Lippincott Williams & Wilkins; 2014:pp.722-996.
• 4. Fugelli CG, Westlye ET, Ersdal H, Strand K, Bjørshol C. Combined interscalene brachial plexus and superficial cervical plexus nerve block for midshaft clavicle surgery: a case series. AANA J 2019;87:374-8.
• 5. Banerjee S, Acharya R, Sriramka B. Ultrasound-guided inter-scalene brachial plexus block with superficial cervical plexus block compared with general anesthesia in patients undergoing clavicular surgery: a comparative analysis. Anesth Essays Res 2019;13:149-54.
• 6. Shanthanna H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle. Indian J Anaesth 2014;58:327-9.
• 7. Peter JD, Christopher JB, Donald M, Clark M, Anthony JW, James BD, et al. History of standard scoring, notation, and summation of neuromuscular signs. A current survey and recommendation. J Peripher Nerv Syst 2005;10:158-73.
• 8. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391-400.
• 9. Herring AA, Stone MB, Frenkel O, Chipman A, Nagdev AD. The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med 2012;30:1263-7.
• 10. Dobie KH, Shi Y, Shotwell MS, Sandberg WS. New technique targeting the C5 nerve root proximal to the traditional interscalenesonoanatomical approach is analgesic for outpatient arthroscopic shoulder surgery. J Clin Anesth 2016;34:79-84.
• 11. Deng Y, Li Y, Yao Y, Feng DD, Xu M. [C5-6 nerve root block technique for postoperative analgesia of shoulder arthroscope: a randomized controlled trial]. Beijing DaXueXueBao Yi Xue Ban 2019;51:177-81. [Article in Chinese]
• 12. Shin HJ, Na HS, Oh AY, Hwang J-W, Kim B-G, Park H-P, et al. A prospective, randomized and controlled study of interscalene brachial plexus block for arthroscopic shoulder surgery: a comparison of C5 and conventional approach, a CONSORT-compliant article. Medicine (Baltimore) 2016;95:e4921.
• 13. Vandepitte C, Latmore M, O'Murchu E, Hadzic A, Van de Velde M, Nijs S. Combined interscalene-superficial cervical plexus blocks for surgical repair of a clavicular fracture in a 15-week pregnant woman. Int J ObstetAnesth 2014;23:194-5.
• 14. Shanthanna H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle. Indian J Anaesth 2014;58:327-9.
• 15. Kline JP. Ultrasound-guided placement of combined superficial cervical plexus and selective C5 nerve root catheters: a novel approach to treating distal clavicle surgical pain. AANA J 2013;81:19-22.
• 16. Salvadores de Arzuaga CI, NayaSieiro JM, Salmeron Zafra O, González Posada MA, Marquez Martínez E. Selective low-volume nerve block for the open surgical fixation of a midshaft clavicle fracture in a conscious high-risk patient: a case report. AA Case Rep 2017;8:304-6.
• 17. Zhou Y, Yudi H, Tang Y, Cui Y, Tian W. Application of ultrasound-guided selective cervical nerve root block for patients undergoing arthroscopic surgery in perioperative period. J Clin Anesthesiol 2017;33:1167-70.