Regional anesthesia for clavicle fractures in emergency medicine: A scoping review

Abstract

Background: Regional anesthesia (RA) has emerged as an alternative technique for managing pain from clavicle fractures in emergency medicine (EM). However, comprehensive data on how RA practices have evolved in EM are lacking. Objectives: In this study, we aimed to systematically review the characteristics of both published and unpublished research on the use of RA for clavicle fractures in EM. Methods: Relevant publications were retrieved from ClinicalTrials.gov, Cochrane Library, Embase, PubMed, Web of Science, and Google Scholar up to September 2024. Studies focused on RA for clavicle fractures in EM were included. The study outcomes included geographic distribution, publication in EM journals, article type, study setting, specialties of RA providers, patient characteristics, and RA techniques used in clavicle fractures. Results: Eight eligible publications were included, comprising three reviews, three case reports, and two research articles. Overall, four RA techniques were documented in the EM literature: the superficial cervical plexus block, interscalene block, supraclavicular nerve block, and clavipectoral plane block. All research articles and case reports reported a reduction in pain scores following RA. Emergency physicians were the primary providers of RA. Most publications focused on the use of single-shot ultrasound-guided techniques with long-acting regimens. Conclusion: This scoping review from reviews, research articles, and case reports highlights the effectiveness of RA for managing clavicle fractures in EM, although the literature remains limited. With the limitation of the scoping review, our findings should be interpreted as preliminary and hypothesis generating rather than definitive evidence of the effectiveness of RA for clavicle fracture management. Further prospective high-quality studies are needed to support these findings.