Ultrasound-Guided Supraclavicular Nerves Block for Acute Pain Management in Clavicular Fractures-A Pragmatic Randomized Trial.

Background/Objectives: This pragmatic randomized controlled trial evaluated the efficacy of ultrasound-guided supraclavicular nerve (SCLN) block compared to standard pain management in patients with acute displaced clavicle fractures (CFs) in an emergency department (ED) setting. Secondary outcomes included time to first request for analgesics, opioid consumption, and patient satisfaction. Methods: Forty-one patients with acute displaced CFs were randomized to receive either an SCLN block (n = 19) or routine pain management (n = 22). Pain intensity was recorded at admission and at 1, 2, 4, 6, 12, and 24 h. Patient satisfaction was assessed after 24 h. Analgesic use, adverse reactions, and adverse events were documented for 24 h. Results: Pain intensity, measured by the numeric rating scale (NRS), was significantly lower in the SCLN group at all time points within the first 12 h (p < 0.001). After one hour, 68% of patients in the SCLN group reported an NRS of 0-2, compared to 19% in the control group. The time to first request for analgesics was markedly longer in the SCLN group (9.1 h vs. 0.7 h). In two patients, SCLN visualization was insufficient, and a cervical plexus block was performed instead. Four patients in the SCLN block group reported adverse reactions. Patient satisfaction after 24 h was significantly higher in the SCLN group (p < 0.001), with 85% indicating they would choose the block again. Conclusions: Ultrasound-guided selective SCLN block appears to be an effective and well-tolerated method for acute analgesia in patients with displaced CFs, with the most pronounced benefit observed during the first 12 h. Patient acceptance of the procedure was high.