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LETTER TO THE EDITOR

Cervical Plexus Block Provides Postoperative Analgesia After Clavicle Surgery

Department of Anesthesiology; Columbia University College of Physicians and Surgeons; New York, NY; aa394{at}columbia.edu

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).

View larger version (133K): [in this window] [in a new window]   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.

References

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.[Free Full Text]
3. Head H, Campbell AW. The pathology of herpes zoster and its bearing on sensory localization. Brain 1900;23:353–523.[Free Full Text]
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.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Choi, D. S. Articles by Brown, A. R. Search for Related Content PubMed PubMed Citation Articles by Choi, D. S. Articles by Brown, A. R.