Ultrasound-guided interscalene block is effective for anesthesia and postoperative analgesia for clavicle fracture surgery

Abstract

Background & Objective: General anesthesia is commonly used during clavicular fracture surgery; however, it has been associated with hemodynamic fluctuations, airway and respiratory problems, stress response, and postoperative nausea and vomiting. We assessed the effectiveness and side effects of ultrasound-guided interscalene block when used for anesthesia and postoperative analgesia for clavicle fracture surgery. Methodology: This study was conducted on 48 patients who were planned for clavicle fracture surgery. Patients were given premedication with midazolam 0.05 mg/kg and pethidine 0.5-1 mg/kg intramuscularly. Patients received ultrasound-guided interscalene block using nerve stimulator and 0.5% ropivacaine 30 ml or bupivacaine 0.375%. Postoperatively, almost all patients received non-steroidal anti-inflammatory drugs (NSAIDs) (COX-1 or COX-2). Postoperative pain was evaluated using a visual analog scale (VAS) at 12, 24, 36, and 48 h postoperatively. Patients received a rescue dose of intravenous fentanyl when the VAS > 4. Block was successful if the surgery was completed without shifting to general anesthesia. The data was analyzed using the T-test and Man Whitney-test using SPSS 20. Result: 95.83% of patients received a successful block. The mean pre-operative VAS was 3.48 ± 1.27 and significantly decreased in the post-operative period; 1.48 ± 0.77 (12 h post-op), 1.79 ± 1.05 (24 h post-op), 1.21 ± 0.41 (36 h postop), and 1.04 ± 0.20 (48 h postoperative) (p=0.000). The preoperative and postoperative mean arterial pressure (MAP) and pulse rate of the patients remained stable. There was no incidence of nausea, vomiting, or other complications. Conclusion: Ultrasound-guided interscalene block is effective and safe as an anesthetic and for postoperative analgesia in clavicle fracture surgery.