Effectiveness of supraclavicular nerve and upper trunk of brachial plexus (SCUT) block versus clavipectoral fascia and supraclavicular nerve block (CPFS) in mid-shaft clavicle fracture surgery - A randomized clinical trial.

BACKGROUND AND AIMS: SCUT blocks the supraclavicular nerve (SCN) and upper brachial plexus trunk, and the clavipectoral fascia block (CPF) blocks the fascia-clavicle nerves. This study compares the SCUT block to the CPFS (CPF block and SCN block), which provides site-specific regional anesthesia (RA) for mid-clavicular surgery.

MATERIAL AND METHODS: A prospective, randomized controlled trial with two parallel arms and 1:1 allocation is presented here. 18-60-year-old ASA class 1 or 2 adults scheduled for unilateral mid-shaft clavicular surgery were studied. Group A received SCUT block (4 mL of 2% lidocaine + adrenaline, 4 mL 0.5% bupivacaine, and 2 mL dexamethasone). Group B received CPFS (CPF block and SCN block) with 16 mL of 2% lidocaine + adrenaline, 16 mL of 0.5% bupivacaine, and 2 mL of dexamethasone. Outcomes included block success, partial block success, failure, analgesia duration, and shoulder abduction after block.

RESULTS: A total of 30 patients per group were studied. In the SCUT group, block onset time was 5 (2) min, with a 93% success rate, a procedure time of 12 (5) min, and an analgesia duration of 15 (1.75) hours. In comparison, CPFS block onset time was 6 (2) min, success rate was 80%, procedure time was 12 (3) min, and analgesia duration was 6 (2) hours. Shoulder abduction was absent in the SCUT group but present in the CPFS group in all blocked patients.

CONCLUSION: The SCUT and CPFS blocks are effective and site-specific for mid-shaft fracture clavicle surgery. However, the duration of analgesia is longer with the SCUT block requiring a lower drug volume. The CPFS block allows better shoulder movement. Both blocks have similar success rates, onset times, and procedure times.