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Subarachnoid block (SAB), a fundamental technique in regional anesthesia, offers efficient anesthesia for various surgical procedures with advantages including rapid onset, reliable anesthesia, and reduced systemic effects compared to general anesthesia. Hyperbaric ropivacaine, a long-acting local anesthetic, has gained popularity due to its favorable pharmacokinetic profile and safety profile. However, to extend the duration and enhance the quality of anesthesia provided by hyperbaric ropivacaine, adjuvants such as dexmedetomidine and clonidine are frequently employed. This comprehensive review explores the roles of dexmedetomidine and clonidine as adjuvants to hyperbaric ropivacaine in SAB. It examines their pharmacological mechanisms, clinical efficacy, safety profiles, and comparative effectiveness in prolonging analgesia and enhancing anesthesia. The review synthesizes evidence from clinical studies to delineate the synergistic effects of these adjuvants, their impact on patient outcomes, and their potential advantages over traditional anesthesia techniques. Through a detailed analysis of current literature and clinical practices, this review aims to provide insights into optimizing the use of dexmedetomidine and clonidine in SAB protocols. It discusses clinical implications, offers recommendations for practice, and identifies future research directions to further enhance the efficacy and safety of SAB using these adjuvants.

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Introduction: Aortic stenosis is a cause of mortality or morbidity. It complicates the selection and management of anesthetic procedures. The aim of this study was to evaluate the efficacy, hemodynamic effects and postoperative outcome of unilateral spinal anesthesia in geriatric patients with hip fractures with moderate or severe aortic stenosis. Material and Method: A retrospective observational study was conducted on geriatric high-risk patients with cardiac conditions who underwent surgery for hip fractures under unilateral spinal anesthesia with low-dose hyperbaric bupivacaine. The study period spanned from January 2018 to December 2021. The inclusion criteria were individuals with moderate to severe aortic stenosis, as defined by the American Heart Association Criteria. Data on demographic information, cardiac pathologies, hemodynamic data, data on motor and sensory block, perioperative complications, and mortality rates at 30th and 180th days were collected. Results: Mortality rates at the 30th day and 180th day were 8.9% (n:4) and 24.4% (n:11), respectively. T6 level was predominantly obtained level of anesthesia (44.4%). Motor and sensory block formation times averaged 7.6 and 4.8 minutes, respectively. Surgical procedures were performed mostly within 1 hour (66.7%), and complications were rare (11.1% hypotension). Initial analgesic effect showed a rapid resolution, with 64.4% of patients requiring analgesic within the first hour postoperatively. Conclusion: In elderly patients with moderate to severe aortic stenosis scheduled for hip fracture surgery, we posit that unilateral spinal anesthesia with ultra-low dose is safe and effective option.

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The erector spinae plane (ESP) block is an increasingly utilized regional block in the emergency department, representing one effective alternative or adjunct to opioid analgesia in patients presenting with rib fractures. While there is growing interest, its widespread adoption faces hurdles, such as a lack of appropriate training resources. Gelatin-based phantoms to simulate human anatomy have been widely used to facilitate ultrasound-guided procedures, although no such model for the ESP block has yet been defined in the literature. To address this gap, we sought to design and assemble an inexpensive, simple to build, reusable phantom to simulate the sonographic anatomy of the posterior thoracic wall and serve as a task trainer for an ultrasound-guided ESP block. This novel phantom model reproduces an ultrasonographic fascial plane using a gelatin medium and 3D-printed thoracic spine with ribs allowing for needle guidance and hydrodissection.

RéSUMé: Le bloc plan érecteur-épine (ESP) est un bloc régional de plus en plus utilisé dans les services d'urgence, représentant une alternative efficace ou un complément à l'analgésie opioïde chez les patients présentant des fractures des côtes. Bien que l'intérêt grandisse, son adoption généralisée se heurte à des obstacles, tels que le manque de ressources de formation appropriées. Les fantômes à base de gélatine pour simuler l'anatomie humaine ont été largement utilisés pour faciliter les procédures guidées par ultrasons, bien qu'aucun modèle de ce type pour le bloc ESP n'ait encore été défini dans la littérature. Pour combler cette lacune, nous avons cherché à concevoir et assembler un fantôme peu coûteux, simple à construire et réutilisable pour simuler l'anatomie échographique de la paroi thoracique postérieure et servir d'entraîneur-tâche pour un bloc ESP guidé par ultrasons. Ce modèle fantôme reproduit un plan fascial échosonographique utilisant un milieu gélatineux et une colonne thoracique imprimée en 3D avec des nervures permettant le guidage de l'aiguille et l'hydrodissection.

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BACKGROUND: Despite increasingly wider use, there remains controversy among anesthesiologists regarding preferred formulations and the role of steroid adjuvants in regional anesthesia. There is also uncertainty in the role of dexamethasone when administered directly versus peripherally. We hypothesize that directly mixing dexamethasone into the regional nerve block rather than peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy concerning duration and rebound pain, decreased postoperative pain scores, or opioid consumption within the short-term postoperative period. METHODS: A prospective, randomized controlled blinded study was conducted for patients undergoing open reduction and internal fixation with a volar plate technique for distal radius fractures. Patients were randomized for their preoperative anesthesia. One group had ultrasound-guided supraclavicular block with ropivacaine with a direct mix of dexamethasone 4 mg (Direct group), while the other group had ultrasound-guided supraclavicular block with ropivacaine and peripheral intravenous dexamethasone 4 mg (Indirect group). Data was collected pre, intra, and postoperatively. RESULTS: Fifty patients consented and participated in the study, with 27 participants in the direct group and 23 participants in the indirect group. Compared to intravenous administration, directly administered dexamethasone demonstrated a significant difference in the average time for the block to fade, onset of motor and sensory recovery, and block resolution. CONCLUSION: Our findings prove that directly mixing dexamethasone compared to peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy with regards to duration and rebound pain, but do not prove that there will be a difference in decreased postoperative pain scores or opioid consumption within the 24-hour postoperative period. LEVEL OF EVIDENCE: Prognosis Level I.

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The use of a retrobulbar anesthetic block for surgery of the posterior chamber is a common, effective, and safe practice, although not without risks. This clinical case aims to describe one of the most feared complications of this ophthalmic block, which demands a high degree of suspicion and agility for proper diagnosis and management. A 91-year-old female patient, physical status ASA III, presents for vitrectomy via pars plana of the left eye due to retinal detachment. Light sedoanalgesia was performed, as well as a left retrobulbar block with 5 mL of local anesthetic. Approximately two minutes after the injection of the local anesthetic, she developed a sudden clinical decline of consciousness, accompanied by bilateral photoplegic mydriasis, sinus tachycardia, and hypertension, followed by central apnea. Orotracheal intubation and connection to a ventilatory prosthesis were performed, maintaining adequate oxygenation, ventilation, and hemodynamic stability. No abnormal findings were found in complementary diagnostic methods. The condition progressively reversed, with a gradual return to the initial state of consciousness, and it was possible to successfully extubate the patient after four hours. The patient remained stable, under surveillance, and was discharged home after 48 hours with no neurological impairment or ophthalmological complications. The clinical findings are compatible with brainstem anesthesia, explained by the dispersion of the local anesthetic into the subarachnoid space, through an inadvertent puncture of the ophthalmic artery or the meninges that involve the optic nerve. Although this event is a rare complication, a low threshold of suspicion should be maintained, given the potential severity of the clinical condition. Early recognition should be followed by a systematic A-B-C-D-E approach, and the outcomes are often favorable. Careful surveillance and monitoring should accompany the performance of ophthalmic surgical procedures, and the presence of an anesthesiologist is essential for the quality of the services provided and patient safety.

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INTRODUCTION/BACKGROUND: The repeated or lengthy use of general anesthesia (GA) in children under three years old is cautioned against due to potential neurodevelopment effects. Spinal anesthesia (SA) has emerged as a safe and effective alternative for routine pediatric urologic procedures. In this study, we describe the use of SA in the urgent surgical treatment of neonatal testicular torsion. OBJECTIVE: We aim to evaluate the safety and efficacy of SA for urgent scrotal exploration in neonates. STUDY DESIGN: We retrospectively collected data on neonates younger than 30 days old undergoing SA for the indication of testicular torsion from May 2018 to June 2022. We recorded patient demographics, adjuvant medications use, and time points for start/stop of spinal injection, procedure, and operating room utilization. RESULTS: Six neonates, with an average age of 1.9 days of life and average weight of 3.4 kg, underwent scrotal exploration for testicular torsion using SA. Four patients (67%) required orchiectomy of the nonviable torsed testicle, and all patients underwent orchiopexy of the unaffected testicle. Mean total operative time was 45.3 (SD 11.7) minutes, including Gomco circumcision in five patients. One patient received preoperative intranasal dexmedetomidine for sedation. Mean time for SA administration was 6.3 (SD 5.5) minutes, with a mean total time in the operating room of 77.3 (SD 9.8) minutes. There were no perioperative or postoperative complications. DISCUSSION: We describe a single institution experience of surgical management of neonatal torsion under SA. In this case series, SA was safely utilized for all neonates involved without the need for conversion to GA or intravenous (IV) sedation. CONCLUSION: The use of SA is safe and efficacious for urgent scrotal exploration for testicular torsion in neonates, even those under 48 h of age. More widespread utilization requires collaboration between pediatric urologists and experienced pediatric anesthesiologists trained in SA.

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BACKGROUND: The analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block. METHODS: Thirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic. RESULTS: The US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia. CONCLUSION: US-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery. CLINICAL TRIAL REGISTRATION: https://classic. CLINICALTRIALS: gov/ct2/show/NCT06009302 , identification number: NCT06009302, date of registration: 18/08/2023.

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INTRODUCTION: Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis. METHODS: A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2-3 months and 6 months post-surgery. RESULTS: Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2-3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2-3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2-3 months post-VATS compared to PVB, ICNB, or TEA. CONCLUSIONS: PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS.

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PURPOSE: Charcot-Marie-Tooth (CMT) disease is an inherited neurologic disorder characterized by progressive peripheral neuropathies. The use of peripheral nerve blocks (PNB) in patients with CMT disease has been controversial because of concerns about exacerbating existing neurologic impairments and the "double hit" hypothesis. We aimed to assess the use of PNB in pediatric patients with CMT disease undergoing orthopedic surgery to address the limited data available in the literature on this topic. METHODS: In this retrospective cohort study, we included all pediatric patients with CMT disease scheduled for orthopedic surgery receiving PNB at our centre. All of the patients had preoperative neurologic exams and received one or more ultrasound-guided regional anesthesia techniques. Data extracted included details of anesthesia technique, surgical procedure, opioid consumption, and pain scores during the first three postoperative days. We also reviewed any complications such as neurologic deficits and local anesthetic toxicity. We used descriptive statistics to summarize the findings. RESULTS: We included 25 patients, 14 of whom (56%) presented with pre-existing neurologic deficits, primarily in the lower extremities. Postoperative assessments revealed no new neurologic impairments in 24/25 (96%) patients, with only one patient experiencing a nerve injury possibly related to the surgical procedure. Opioid consumption was low in the postanesthesia care unit and on the day of surgery. No additional complications were noted in the first 72 hr after surgery. CONCLUSION: Despite concerns, PNB showed favourable outcomes in a pediatric cohort with CMT disease, with low opioid consumption and pain scores and minimal complications during follow-up. These findings match previous reports of adult patients with CMT disease and suggest that the benefits of PNB may outweigh the perceived risks in pediatric patients with CMT disease.

RéSUMé: OBJECTIF: La maladie de Charcot-Marie-Tooth (CMT) est une maladie neurologique héréditaire caractérisée par des neuropathies périphériques progressives. L'utilisation de blocs nerveux périphériques (BNP) chez la patientèle atteinte de CMT est controversée en raison des inquiétudes concernant l'exacerbation des déficiences neurologiques existantes et de l'hypothèse d'une « double insulte ¼. Notre objectif était d'évaluer l'utilisation de BNP chez les patient·es pédiatriques atteint·es de CMT bénéficiant d'une chirurgie orthopédique afin de pallier les données limitées disponibles dans la littérature à ce sujet. MéTHODE: Dans cette étude de cohorte rétrospective, nous avons inclus tou·tes les patient·es pédiatriques atteint·es de CMT devant bénéficier d'une chirurgie orthopédique et recevant un BNP dans notre centre. Tou·tes ont bénéficié d'examens neurologiques préopératoires et ont reçu une ou plusieurs techniques d'anesthésie régionale échoguidées. Les données extraites comprenaient des détails sur la technique d'anesthésie, l'intervention chirurgicale, la consommation d'opioïdes et les scores de douleur au cours des trois premiers jours postopératoires. Nous avons également examiné toutes les complications telles que les déficits neurologiques et la toxicité des anesthésiques locaux. Nous avons utilisé des statistiques descriptives pour résumer les résultats. RéSULTATS: Nous avons inclus 25 patient·es, dont 14 (56 %) présentaient des déficits neurologiques préexistants, principalement dans les membres inférieurs. Les évaluations postopératoires n'ont révélé aucune nouvelle déficience neurologique chez 24 patient·es sur 25 (96 %), une seule personne ayant subi une lésion nerveuse possiblement liée à l'intervention chirurgicale. La consommation d'opioïdes était faible en salle de réveil et le jour de l'opération. Aucune complication supplémentaire n'a été notée dans les 72 premières heures après la chirurgie. CONCLUSION: Malgré les inquiétudes, le BNP a montré des résultats favorables dans une cohorte pédiatrique atteinte de CMT, avec une faible consommation d'opioïdes et des scores de douleur et des complications minimes pendant le suivi. Ces résultats correspondent à des comptes rendus antérieurs de patient·es adultes atteint·es de CMT et suggèrent que les avantages des BNP pourraient l'emporter sur les risques perçus chez la patientèle pédiatrique atteinte de CMT.

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Brugada syndrome (BS) is characterized by abnormal repolarization in cardiac cells, occurring in the absence of structural heart disease, which elevates the risk of ventricular arrhythmias and sudden cardiac death. While most BS patients are asymptomatic, a notable percentage experience syncope or sudden cardiac death. Diagnosis is primarily based on electrocardiographic (ECG) findings. A 40-year-old male with a history of syncope and a family history of sudden cardiac death was scheduled for urgent clavicle osteosynthesis. Preoperative ECG revealed type 1 BS. A multidisciplinary approach was taken, and anesthetic management involved combined general and regional anesthesia, utilizing ultrasound-guided clavipectoral and superficial cervical blocks. Postoperative pain was managed with paracetamol and ketorolac. The patient remained stable throughout the procedure, was monitored for 36 hours postoperatively, and was discharged without complications. BS poses significant perioperative risks, necessitating careful anesthetic management. This case report highlights the successful use of combined general and regional anesthesia in a BS patient, contributing to the limited evidence on safe anesthesia practices for this pathology.

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Background As total knee arthroplasty is one of the most common surgeries in the United States, it is important to identify regional anesthesia methods that optimize patient recovery. This study evaluates the effectiveness of adductor canal (AC) blocks with liposomal bupivacaine (LB) compared to other regional anesthesia techniques. We hypothesized that patients receiving single-shot (SS) AC blocks with LB would have lower postoperative opioid consumption compared to other groups. Methods A retrospective cohort analysis was conducted on patients from a single institution between January 2014 and December 2021. The primary outcome assessed was postoperative opioid use, with secondary outcomes including postoperative pain scores and hospital length of stay. Results The final analysis included 280 patients: 41 received an SS AC block with plain local anesthetic, 76 received a peripheral nerve catheter (PNC) with continuous ropivacaine, 79 received an SS AC block with LB, and 84 received no block. In fully adjusted models, postoperative opioid consumption on day one was significantly lower in the SS AC block with LB group compared to the no block group (b = 23.2, SE = 5.7, p < 0.0001), the PNC group (b = 15.5, SE = 5.7, p = 0.01), and the SS AC block with plain local anesthetic group (b = 18.9, SE = 6.9, p = 0.01). Additionally, hospital length of stay was significantly reduced in the LB group compared to the no block group (b = 1.5, SE = 0.3, p < 0.0001), the PNC group (b = 1.1, SE = 0.3, p < 0.0001), and the SS AC block with plain local anesthetic group (b = 1.5, SE = 0.3, p < 0.0001). Conclusions Patients who received an AC block with LB had higher pain scores on postoperative day 0 (POD0) but required less opioid medication on postoperative day 1 (POD1) and had a shorter hospital stay compared to patients who received other types of AC blocks or no block.

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PURPOSE: The operative treatment of mid-shaft clavicle fractures shows benefit in union rates, return to work, and lower pain scores relative to non-operative treatment. We sought to determine if the surgical treatment of isolated mid-shaft clavicle fractures would result in fewer opioids prescribed as compared to those managed non-operatively. METHODS: All mid-shaft clavicle fractures treated at a Level 1 trauma center were identified from 2012 to 2016. Demographics, fracture characteristics, surgical complications/outcomes, non-operative outcomes, and all narcotics prescribed for 6 months post-injury were collected. Narcotic prescriptions, in morphine equivalents (ME), were obtained through the state prescription drug monitoring program (PDMP). RESULTS: One hundred and ten operative and 48 non-operative patients were included. Age, gender, previous alcohol, tobacco or drug use, and final range of motion were similar between groups. Pre-treatment fracture shortening (1.8 cm vs. 0.7 cm, p < 0.001) and displacement (150% vs. 70%, p < 0.001) were greater in the operative group. Total ME's (604 vs. 187, p < 0.001) and post-operative ME's (420 vs. 187, p < 0.001) were greater for the operative group. In either group, no other variable influenced ME's prescribed. CONCLUSION: Clavicles treated operatively receive substantially more opiates than those treated non-operatively, despite data suggesting that operative treatment makes clavicle fractures less painful. The total amount of narcotic analgesics obtained by operatively treated patients was over three times that obtained by non-operatively managed patients, which equates to 55 5 mg oxycodone pills or 85 5 mg hydrocodone pills per patient. While there may certainly be advantages to the operative treatment of clavicle fractures, they must be weighed against the risks of a significant increase in opiate prescribing and potential consumption.

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OBJECTIVE: To compare perioperative opioid consumption in dogs undergoing pelvic limb surgeries and receiving a lumbosacral plexus block by combining a lumbar [lateral pre-iliac (LPI)] block with a lumbosacral trunk [i.e. parasacral (PS group) or greater ischiatic notch plane (GIN group)] block. Study design Retrospective, descriptive, exploratory, noninferiority cohort study. METHODS: Medical records of 37 client-owned dogs were analyzed. Intraoperative (primary outcome) and postoperative (24 hours) opioid use, 24 hour cumulative pain scores and prevalence of complications were compared between the two groups. Opioid use was quantified in morphine equivalents (ME, mg kg-1 ). The noninferiority limit for intraoperative opioid consumption was set at 0.05 ME kg-1 hour-1. Demographic data, procedure duration, surgery type and perioperative dexmedetomidine and ketamine use were also collected. A t-test or Wilcoxon rank-sum test, a Fisher's exact test and multivariable linear regression were used. Significance was set at p < 0.05. RESULTS: The GIN and PS groups comprised 17 and 20 dogs, respectively. Total intraoperative ME consumption was 0.17 (0.11-0.21) and 0.22 (0.16-0.30) mg kg-1 hour-1 for the GIN and PS groups, respectively (p = 0.077). The noninferiority analysis adjusted by surgery type and body mass revealed that the mean difference between the groups (GIN - PS) was -0.039 (95% CI -0.11-0.03, p = 0.247) ME mg kg-1 hour-1, indicating that the GIN group was not inferior to the PS group regarding intraoperative ME consumption. Dexmedetomidine and ketamine use, postoperative ME consumption and pain scores were similar between groups. CONCLUSIONS AND CLINICAL RELEVANCE: This retrospective study and preliminary observations support the clinical use of the GIN plane block, demonstrating its noninferiority to the PS block when combined with the LPI block for multimodal perioperative analgesia in dogs undergoing pelvic limb surgeries.

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Background A common knee joint disorder is injury to the anterior cruciate ligament (ACL), which often requires surgery. Proper pain control after the surgery facilitates fast recovery and prevents chronic pain. To provide analgesia for knee procedures, the use of opioids, non-steroidal anti-inflammatory medications, and regional techniques are commonly employed. This study aims to evaluate the efficacy of adductor canal block (ACB) and femoral nerve block (FNB) for postoperative pain management after anterior cruciate ligament reconstructions (ACLRs). Methodology This prospective interventional study included 30 participants scheduled for patellar graft ACLR. They were assigned into groups, i.e., ACB and FNB, with 15 patients each. The evaluation occurred one day before the operation, and all surgical procedures were performed using spinal anesthesia. During the postoperative period, a 10-point visual analog scale (VAS) was utilized to quantify pain intensity at the end of the surgery and at various intervals after the surgery. Patients with a VAS score greater than 4 received either FNB or ACB using bupivacaine 0.125%. Duration of analgesia time, power of quadriceps muscle, and neurologic complications were documented. Results No statistically significant value was observed in the mean duration of analgesia between the patients in ACB (348.33 minutes) and the patients in FNB (363.06 minutes). No motor block was observed in 12 patients who received ACB, while only four patients had a motor-sparing effect among those who received FNB. No neurological adverse effects were observed in the study participants. Conclusions ACB provides an equal duration of analgesia similar to FNB, and ACB significantly spares motor strength and maintains higher quadriceps power than FNB.

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Anesthesia in patients with emphysematous giant bulla undergoing non-thoracic surgery is challenging and can cause serious complications. We report a successful case of lip mass resection in a 65-year-old male with paraseptal emphysema and giant bullae under regional anesthesia using a mental nerve block. The patient presented with a slow-growing ulcerative mass on his lower lip and had a history of non-compliant COPD management. An excisional biopsy was planned. Preoperative workup revealed extensive lung pathology with giant bullae. General anesthesia with positive pressure ventilation in patients with emphysematous giant bullae can cause compression of lung parenchyma, vena cava kinking, circulatory collapse, and even death. To circumvent such risks, regional anesthesia was preferred and surgery was successfully done under ultrasound-guided bilateral mental nerve block. The procedure was uneventful, with stable hemodynamics throughout.

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Ultrasound-guided clavipectoral fascial plane block (CPB) and intermediate cervical plexus block (ICPB) have been used as novel approaches for clavicular fracture surgery in adults. However, there are few reports of ultrasound-guided CPB combined with ICPB for clavicular surgery in children under 18 years of age. A 16-year-old male baseball player (weight, 57 kg; height, 160 cm) was scheduled to undergo open reduction and internal fixation with superior plate placement for a left-sided displaced midshaft clavicular fracture. We performed ultrasound-guided CPB using 0.25% ropivacaine (10 mL each) on the medial and lateral sides of the clavicle fracture between the periosteum of the clavicle and the clavipectoral fascia and ICPB using 0.25% ropivacaine (5 mL) under general anesthesia. The surgery proceeded smoothly, and the postoperative pain was minimal. In this case, ultrasound-guided CPB combined with ICPB was used effectively and safely to treat clavicular fractures in an adolescent athlete.