152 Regional anesthesia for correction of clavicle fracture in a polytrauma patient diagnosed with severe Obstructive Sleep Apnea (OSA)

Background and Aims Clavicle surgery can be performed under general or regional anesthesia; the latter is preferred when there´s interest in avoiding complications associated with general anesthesia. Multiple rib fractures are associated with significant morbidity such as ventilatory compromise, increased rate of atelectasis, lung contusion and pneumonia. If invasive mechanical ventilation can be avoided, intensive care unit stay and complications from mechanical lung ventilation can be prevented. Methods A 78-year-old male patient weighing 80 Kg and with severe OSA presented to our emergency department with a left clavicle fracture and left costal arc fractures from T1 to T10 after an accidental fall. After stabilization the patient was scheduled for surgical correction of the clavicle fracture. After obtaining consent to perform surgery under regional anesthesia and conscious sedation, we administered 50 mcg of fentanyl and initiated a dexmedetomidine infusion. We performed different ultrasound guided nerve blocks with Ropivacaine 0.5%: 5 mL were administered at the interscalene groove to block the brachial plexus, 5 mL targeted at the supraclavicular nerves and 10 mL at the clavipectoral fascial plane. Results The patient reported no pain throughout the procedure and there was no ventilatory compromise or need for intubation. In the first 24 postoperative hours, the patient did not report pain, either at rest or movement, without need of rescue analgesia. Conclusions The use of peripheral nerve blocks allowed for surgical correction of clavicle fracture in our patient, while avoiding pulmonary complications associated to invasive mechanical ventilation, difficult ventilatory weaning, and prolonged stay at the intensive care unit.