ANESTHETIC MANAGEMENT OF A PATIENT WITH FRACTURED CLAVICLE WITH PLATE IN SITU ROLE OF SITE-SPECIFIC NERVE BLOCK – A CASE REPORT

Abstract

Surgery of the clavicle with fixation of plate is being done more commonly in the recent years with an intention to give optimal functional outcomes. A repeat injury with broken clavicle with plate in situ is relatively rare. A 30-year-old 90 kg male with a BMI of 30 was posted for open reduction and fixation. There was no comorbid illness except a difficult airway. The routine investigations were normal. The plan was to administer Partha’s combo block as the patient was obese with difficult airway. There was laceration in the side of front of neck which was painful. An ultrasound-guided superficial cervical plexus block with 5 ml of 0.5% bupivacaine was given to block the side of front of neck and the skin in front of clavicle. This provided a pain-free needling of brachial plexus. The upper trunk of the brachial plexus was blocked with 8 ml of 0.5% bupivacaine. Another 15 ml of 0.25% bupivacaine was administered in the Clavipectoral fascia plane to knock out any possible failure of the above blocks. The presence of a plate and a previous scar made the block challenging. Three milliliters of 0.25% bupivacaine were used in the middle of chest to block the nerves from the other side. The surgery was uneventful and the duration was 2 h. Only 25 μg of intravenous fentanyl was used intraoperatively. This case report is presented for its rarity, where a non-virgin clavicle was fixed with combined site-specific blocks in an obese patient with difficult airway.