Ultrasound-Guided Combined Interscalene–Superficial Cervical Plexus Block versus Interscalene Block Alone for Surgical Anesthesia in Clavicle Fractures: A Comparative Study

Abstract

Background: Regional anesthesia techniques for clavicular fracture surgery are increasingly used as safe alternatives to general anesthesia. The combined interscalene and superficial cervical plexus block may provide more complete anesthesia than interscalene block alone. This study compared the anesthetic efficacy of ultrasound-guided combined interscalene–superficial cervical plexus block versus interscalene block alone in clavicular fracture surgery.

Methods: A prospective comparative study was conducted on 50 adult patients undergoing clavicular fracture fixation from June 2024 to July 2025 at NITOR, Dhaka, Bangladesh. Patients were randomly allocated to Group A (combined interscalene and superficial cervical plexus block) or Group B (interscalene block alone). Both groups received 15 mL of 0.25% ropivacaine with 5 mg dexamethasone for the interscalene block; Group A received an additional 3 mL of 0.25% ropivacaine for the superficial cervical plexus block. Sensory block onset was assessed every 5 minutes using pin-prick, and motor block using the Modified Bromage Scale. Adequate anesthesia was confirmed prior to incision. Rescue analgesia with ketamine 50 mg and atropine 0.2 mg was given for intraoperative pain (VAS ≥ 4).

Results: Group A demonstrated significantly faster onset of sensory and motor block compared to Group B (p < 0.05). Fewer patients in Group A required rescue analgesia or conversion to general anesthesia (p < 0.05). Hemodynamic parameters remained stable in both groups. Minor complications, including breathlessness, bradycardia, and voice change, were slightly more frequent in Group A but were not statistically significant.

Conclusion: Ultrasound-guided combined interscalene–superficial cervical plexus block provides faster onset, more effective anesthesia, and greater safety than interscalene block alone for clavicular fracture surgery, reducing the need for rescue analgesia and conversion to general anesthesia.