AIM: This study aims to compare the Efficacy Of ultrasound-guided clavipectoral
Fascial Plane Block versus Interscalene Brachial Plexus Block Combined With
Superficial Cervical Plexus Block Posted For Clavicle Surgery
PRIMARY OBJECTIVES:
• To assess the success rate of the block
• Ultrasonographic assessment of hemi diaphragmatic paresis by using sigh test
• Modified Bromage scale to assess the upper limb function
SECONDARY OBJECTIVES:
• Assessment of pain by using the VAS score
• Time for the first rescue analgesia
• Look for side effects, including local anaesthetic systemic toxicity and Horner
syndrome
METHODS: A Total of 60 patients with unilateral clavicle fractures of ASA I & II, age
between 18 to 55 who underwent elective internal fixation of clavicle fractures in our
hospital, willing for proposed blocks were included in this study. Randomization was
done by a computer-generated randomized table
Group C: Superficial Cervical Plexus Block and Clavipectoral Fascial Plane Block
(S.C.P.B. and C.P.B.) in 30 patients
Group I: Superficial Cervical Plexus Block and Interscalene Brachial Plexus Block
(S.C.P.B. and I.S.B.P.) in 30 patients
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After informed consent, the blocks were given as per the standard protocol by the same
anaesthetist under ultrasound guidance.
Group C (SCPB AND CPB):
Group I (SCPB AND ISBP):
S.C.P.B. with 7ml of 0.5% Ropivacaine
C.P.B. with 20ml of 0.5% Ropivacaine
S.C.P.B. with 7ml of 0.5% Ropivacaine
I.S.B.P. with 20ml of 0.5% Ropivacaine
At the beginning of the surgery, all patients were administered 0.05 mg/kg of
midazolam.
The primary objectives were measured as the effect of the block was obsseved at 30
min in three areas: the sternoclavicular joint, mid-clavicle and acromioclavicular joint,
Modified Bromage scale (M.B.S.) to assess upper limb movement function and Visual
Analog Score(VAS). The diaphragmatic movement was evaluated by real-time M
mode using ultrasonography of the hemidiaphragm, and adverse reactions like local
anaesthetic systemic toxicity, pneumothorax and haemothorax were also noted.
RESULTS: The study compared the Clavipectoral Fascial Plane Block with
Superficial Cervical Plexus Block (Group C) and the Interscalene Brachial Plexus
Block with the Superficial Cervical Plexus Block (Group I) across multiple
parameters.
Both groups were demographically similar in age (32.83 ± 10.77 vs. 34.57 ± 9.58
years, p = 0.347) and height (1.673±0.053m vs. 1.684 ± 0.043m , p = 0.382), but
Group C had a significantly higher weight (76.53 ± 6.12 vs. 69.80 ± 7.34 kg, p =
0.00005) and BMI (27.33 ± 1.28 vs. 24.67 ± 2.84, p = 0.00003).
Analgesic outcomes favoured Group C, with a longer duration of analgesia (23.23 ±
1.96 vs. 14.23 ± 1.33 hours, p < 0.001) and lower VAS pain scores at 6 hours (0.00 ±
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0.00 vs. 0.87 ± 0.97, p < 0.001), 12 hours (0.87 ± 1.01 vs. 2.80 ± 0.61, p < 0.001),
and 24 hours (2.93 ± 0.94 vs. 6.63 ± 0.81, p < 0.001), demonstrating superior and
prolonged pain relief.
Respiratory function was better preserved in Group C, as diaphragmatic excursion at
30 minutes was significantly greater (5.79 ± 0.52 vs. 2.96 ± 0.60 cm, p < 0.001),
with a lower percentage decrease (95.57%±4.25 vs. 50.21% ± 10.60, p < 0.001),
suggesting reduced risk of respiratory impairment in Group C.
Sensory blockade was effective in both groups, with no significant differences in
block success scores across the sternoclavicular (2.77 ± 0.43 vs2.60 ± 0.50 ,p =
0.171) , midclavicular (3.00 ± 00 vs. 2.90 ± 0.31, p = 0.083), and acromioclavicular
(2.93 ± 0.25 vs. 2.87 ± 0.35, p = 0.398) regions. However, Group I resulted in
significant motor blockade (MBS 2.47 ± 0.57 vs. 0.00 ± 0.00, p < 0.001), whereas
Group C preserved motor function.
Additionally, Group I was associated with hemidiaphragmatic paresis (13%)and
Horner syndrome (2%), complications that were absent in Group C.
CONCLUSION: The results indicate that Clavipectoral Fascial Plane Block had
superior analgesic efficacy, with a significantly longer duration of pain relief and lower
VAS scores at all time points compared to the Interscalene Brachial Plexus Block
combined with Superficial Cervical Plexus Block Additionally, Clavipectoral Fascial
Block was associated with no incidence of hemi diaphragmatic paresis or Horner
syndrome, making it a safer alternative for patients at risk of respiratory complications.
Publication Date: 2026-06-20