الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Pain management after clavicular fracture or surgery is very important. Since initial post-fracture pain may not respond to opioids, peripheral nerve blocks may be a useful complement to oral medication. The clavicle has a complex and variable innervation and it has led to numerous discussions as to which regional anesthetic technique is best suited for preventing postoperative pain in clavicle repairs. Therefore, we aimed in the current study to comprehensively evaluate and to compare the analgesic efficacy of the USguided clavipectoral fascia plane block and the US-guided interscalene brachial plexus block in patients undergoing clavicle surgery. with regards to; postoperative morphine consumption in the first 24 hours after surgery, pain scores and complications of each technique ((local anesthetic systemic toxicity, pneumothorax and diaphragmatic hemiparesis). This prospective randomized controlled study was carried out on 60 participants were admitted to Tanta University Hospitals from March 2022 to September 2023 after approval of the Institutional Ethical Committee to accomplish this. The 60 patients randomly allocated according to technique used into three equal groups; 20 patients enrolled in each group : ❖ GroupI (group C =control group) (n=20): Patients included in this group administrated the standard analgesic protocol only. ❖ group II (group CPB = Clavipectoral fascia plane block group) (n=20): patients included in this group received unilateral US-guided CPB block on the ipsilateral side of the operation after induction of general anesthesia and before start of surgical repair. ❖ group III (GroupISB = Interscalene brachial plexus block group) (n=20): patients included in this group received unilateral US-guided ISB block on the ipsilateral side of the operation after induction of general anesthesia and before start of surgical repair. After induction of general anesthesia, the patients received ultrasound guided CPB block or ISB block before starting the surgery. • The following measurements were recorded: Demographic data includes age, gender, weight, height, BMI, ASA physical status and duration of surgery. Postoperative pain was assessed by Numerical Rating Scale (NRS) Pain score at PACU and at 2,4,6,12,18 and 24 h postoperative. Also, the time to the first call of rescue of analgesia and the total dose of morphine received in the first 24h. As well, total intraoperative fentanyl consumption and patient satisfaction was assessed. Hemodynamic Parameters: (MAP & HR) recorded before block performance, intraoperatively every 30 min and after surgery at T (0, 2,4,6, 12,18, 24h). Assessment of mean diaphragmatic excursion after total recovery of the patients by US done to be compared with the preoperative. Lastly, any undesirable side effects that occurred during the first 24 hours was recorded and treated (e.g., local anesthetic systemic toxicity (LAST), bradycardia, hypotension, pneumothorax and diaphragmatic hemiparesis). • The results of our study can be summarized as following: Demographic data includes, age, gender, weight,, height,, BMI,LBW, ASA physical status and duration of surgery were insignificantly different between the three groups. Post-operative pain (NRS) was statistically significant difference in NRS at rest among the three groups at PACU,2h,4h,12h, 18h and 24 hours but there was no statistically significance difference at 6 hours, while NRS on moving was statistically significant difference among the three groups at PACU,2h,4h,6h, 12h, 18h and 24 hours. Also, the time of 1st rescue analgesia was significantly longer in group II and group III than group I. moreover, there was statistically significant decrease in morphine consumption in group II and group III in comparison with group I. According to intraoperative fentanyl consumption there was statistically significant difference between group I and group II as it was significantly increased in group I compared to group II and by comparing between group I and group III it was significantly increased in group I compared to group III and no statistically significant difference between group II and group III. Regarding to intraoperative heart rate there was no statistically significant difference between the three groups in intraoperative heart rate at 30 min but there was statistically significant difference between the three groups in intraoperative heart rate at 60 min, 90 min and 120 min. While postoperative there was statistically significant difference between the three groups in postoperative heart rate at 2h, 4h, 6h, 12h, 18h and 24hours and there was no statistically significant difference between the three groups in postoperative heart rate at PACU. According to intraoperative MAP there was no statistically significant difference between the three groups in intraoperative MAP at 30 min but there was statistically significant difference between the three groups in intraoperative MAP at 60 min, 90 min and 120 min. While postoperative there was statistically significant difference between the three groups in postoperative MAP at 2h, 4h, 12h and 18hours but there was no statistically significant difference between the three groups in postoperative MAP at PACU, 6h and 24hours. As regard to mean diaphragmatic excursion there was no statistically significant difference between the three groups preoperative but postoperative there was statistically significant difference between the three groups. Patient satisfaction was statistically significant higher in group II and group III compared to group I. There was statistically significant difference between the three groups in Diaphragmatic hemiparesis But as regard hypotension, bradycardia, pneumothorax and LAST there was no statistically significant difference between the three groups.