• Hipólito Labandeyra, Luis F Váldes-Vilches, Alberto Prats-Galino, and Xavier Sala-Blanch.
• From the Laboratory of Surgical Neuroanatomy (LSNA), Human Anatomy and Embryology Unit, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona (HL, AP-G, XS-B), Department of Anesthesia, Hospital HM Nou Delfos (HL), Department of Anesthesia, Hospital Costa del Sol, Marbella (LFV-V) and Department of Anesthesia, Hospital Clínic de Barcelona, Barcelona, Spain (XS-B).
• Eur J Anaesthesiol. 2024 Oct 24.

BackgroundRecent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle.ObjectiveOur hypothesis was that the anaesthetic injectate would fully cover both the anterosuperior and posteroinferior surfaces of the clavicular periosteum in the midclavicular region.DesignObservational human cadaver study.SettingLaboratory of Surgical Neuroanatomy, Unit of Anatomy and Human Embryology of the Faculty of Medicine and Health Sciences, University of Barcelona.ParticipantsFive fresh human cadavers.InterventionsThe cadavers received both a CPB and subclavius muscle injections under ultrasound guidance in 10 clavicular regions.Main Outcome MeasuresAfter the procedures on the cadaveric models, an anatomical dissection by planes was performed to evaluate the distribution pattern of methylene blue on the clavicular periosteum. A probabilistic map of the colour spectrum and staining temperature on the clavicular surfaces was generated.ResultsMethylene blue stained 37 ± 16% of the anterosuperior surface and 23 ± 13% of the posteroinferior surface of the clavicular periosteum, particularly in the middle third of each surface. Although the staining did not achieve complete circumferential coverage or perfect alignment between the surfaces, the areas exhibited a close relationship, indicating significant distribution and relevant coverage.ConclusionOur anatomical study demonstrates that the midclavicular block achieves effective distribution around the middle third of the clavicle, although complete circumferential anaesthesia of the clavicular periosteum was not achieved. Although this block may provide periosteal and bone anaesthesia, it does not address other sources of pain, such as muscle spasms and skin components. Additional clinical studies are needed to evaluate the overall efficacy of this dual block technique for clavicle surgery.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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