I have applied many cervical plexuses block for post operative analgesic effect, but awake clavicula surgery would be very advanced for me and my surgeon. :) very helpful video, thank you for your sharing.
Agree, we have clavicle fracture cases where the surgeons want to evaluate the brachial plexus afterwards and this is a great option for that. Thanks for watching!
Yes, I think that's a great way to do it. It's pretty quick to do so you're not going to take up a lot of surgical time, and it avoids the discomfort of needling the periosteum while awake. Thanks for watching!
Sorry if that wasn't clear...the probe is over the clavicle, with the shoulder to the left side of the screen. The patient's neck and head are in the upper right part of the screen, and the needle is being advanced from the caudal aspect. Hope that helps!
Usually we're combining this with a light general anesthetic with LMA in order to provide patient comfort and immobility, so it's usually just an analgesic block. I have done it sometimes for surgical anesthesia but as @igork7346 mentioned, it's useful to increase the concentration to hasten the onset and provide a denser block (e.g. 0.375% ropivacaine). I'll also do a quick cervical plexus block in order to make SURE that I've blocked the skin fibers over the clavicle. Thanks for watching!
I’ve used this technique for about a year now and absolutely love it. However, I am curious as to how long prior to incision do you perform the clavipectoral fascia block? I ask because I have noticed some patients do great during the case and even in phase 1 of pacu but the block seems to wear off quickly while others get the relief I’d expect 18 to 24 hours.
Hello! In my practise combinate this block with cervical plexus block. 10-15 minutes after block may get surgery (lidocaine 1% + ropivacaine 0.375%). I think only ropivacaine solution will need a little bit more time before surgery.
Glad it's working well for you! I usually use a dilute solution of ropivacaine (0.2%) with epinephrine (2.5 mcg/ml) and dexamethasone (2 mg)--that combo typically provides 16-24 hrs of coverage. Hope that helps!
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Just when I thought there could be no more blocks to describe... you guys bring the knowledge. Appreciate it!
Found another gem. Thanks lots!
I have applied many cervical plexuses block for post operative analgesic effect, but awake clavicula surgery would be very advanced for me and my surgeon. :) very helpful video, thank you for your sharing.
Thanks for watching!
Awesome. So far I’ve used the ISB plus CPB but it’s nice to have an option when avoiding hemiparesis is desired.
Agree, we have clavicle fracture cases where the surgeons want to evaluate the brachial plexus afterwards and this is a great option for that. Thanks for watching!
Great video! Would you consider performing this block after induction of general anesthesia, prior to surgical incision?
Yes, I think that's a great way to do it. It's pretty quick to do so you're not going to take up a lot of surgical time, and it avoids the discomfort of needling the periosteum while awake. Thanks for watching!
Thanks ❤
Thanks for watching!
Excellent sir. Picture at 2.50 doesn't give broad view about needle position, ( location of neck, chest, shoulder etc) please explain it. Thanks
Sorry if that wasn't clear...the probe is over the clavicle, with the shoulder to the left side of the screen. The patient's neck and head are in the upper right part of the screen, and the needle is being advanced from the caudal aspect. Hope that helps!
this block can be used as anesthesia or analgesia ?
I think a both. Low percent solution for analgesia, high percent for anesthesia.
Usually we're combining this with a light general anesthetic with LMA in order to provide patient comfort and immobility, so it's usually just an analgesic block. I have done it sometimes for surgical anesthesia but as @igork7346 mentioned, it's useful to increase the concentration to hasten the onset and provide a denser block (e.g. 0.375% ropivacaine). I'll also do a quick cervical plexus block in order to make SURE that I've blocked the skin fibers over the clavicle. Thanks for watching!
I’ve used this technique for about a year now and absolutely love it. However, I am curious as to how long prior to incision do you perform the clavipectoral fascia block? I ask because I have noticed some patients do great during the case and even in phase 1 of pacu but the block seems to wear off quickly while others get the relief I’d expect 18 to 24 hours.
Hello! In my practise combinate this block with cervical plexus block. 10-15 minutes after block may get surgery (lidocaine 1% + ropivacaine 0.375%). I think only ropivacaine solution will need a little bit more time before surgery.
Do you use any adjuvants?
@@angelgomez5388 yes, decadron. I switched from 0.25% to 0.5% and it seems to work better.
Glad it's working well for you! I usually use a dilute solution of ropivacaine (0.2%) with epinephrine (2.5 mcg/ml) and dexamethasone (2 mg)--that combo typically provides 16-24 hrs of coverage. Hope that helps!
@@mjonesCOthis is for awake anaesthesia?