Naval Medical Center Camp Lejeune
Clavicle fractures are the most common fracture of the shoulder girdle, with young men being the most affected demographic. The incidence of clavicle fracture among military service members is 1.5-3x higher than the general adult population. While many clavicle fractures may be managed non-operatively, surgical intervention for clavicular fractures has shown improved functional outcomes in the active-duty Marine Corps population and an overall satisfactory return-to-duty rate. However, surgical fixation of the clavicle is associated with significant postoperative pain when no local anesthetic techniques are employed. Several regional anesthetic and local infiltrative analgesic regimens have been studied to improve postoperative pain control for clavicle ORIF with the authors concluding that intermediate cervical plexus block is the regional anesthesia therapy of choice for post-operative analgesia. A retrospective study by the same group determined that an intermediate cervical plexus block resulted in lower postoperative pain scores and opioid requirements than surgeon-administered local infiltration analgesia. This retrospective study unfortunately lacked participant blinding, randomization, a standardized anesthetic, consistent block technique, and protocolized postoperative analgesia. To date, no prospective trial has been performed directly comparing these two techniques. We propose, given the significance of clavicle fractures and corrective surgery in the military population, to study the efficacy of ultrasound-guided intermediate cervical plexus blocks as compared to local infiltration analgesia.
ALL PATIENTS (STANDARD CARE) Patients will be administered a standardized anesthetic plan of preoperative anxiolysis (midazolam 2mg) and induction of anesthesia (lidocaine 1-1.5mg/kg, fentanyl 0.5-1.5mcg/kg, propofol 1-3mg/kg, and rocuronium 0.6-1.2mg/kg). Airway management will be at the discretion of the staff anesthesia provider. Following endotracheal intubation, the anesthesia provider will perform an ultrasound-guided intermediate cervical plexus block. Ultrasound imaging will be used to identify the sternocleidomastoid muscle at its midpoint between origin and insertion. An echogenic…
Inclusion Criteria: * Adults aged 18-64 years * Scheduled surgery of the clavicle, acromioclavicular joint, or coracoclavicular ligament at NMCL * ASA Physical Status Classification 1-3 Exclusion Criteria: * Emergent surgery * Concurrent surgery involving the glenobumeral joint or proximal humerus * Prior anaphylactic reaction or known intolerance to study medications * Patient reported or documented opioid use within the last 30 days unrelated to clavicular, AC joint, or CC ligament pathology
local anesthetic (10ml of bupivacaine 5mg/ml)
local anesthetic (20ml of bupivacaine 2.5mg/ml)
placebo (10ml of 0.9% sodium chloride)
placebo (20ml of 0.9% sodium chloride)