Cervical Plexus Block Provides Postoperative Analgesia After Clavicle Surgery
Bibliographic record
Abstract
To the Editor: We report a case of successful postoperative analgesia after clavicular open reduction and internal fixation (ORIF) using a cervical plexus block (CPB). While an interscalene block could provide analgesia, at the price of motor and sensory blockade of the upper extremity, using a CPB, to our knowledge, has not been described before. A healthy 49-year-old woman undergoing right clavicular ORIF was given preoperatively a deep (C2–C4) and superficial CPB according to the classic approach (1) using 0.5% bupivacaine. The surgical procedure was performed under general anesthesia. Following awakening from general anesthesia, the patient was pain-free until 14 hours postoperatively. She then took one dose of oral analgesics before discharge. The innervation of the clavicle and the overlying skin varies depending on the source in the literature between C3 and C6. Figure 1 summarizes the dermatome distributions published by several authors. The clavicle itself has been reported to be innervated either by C4, or by C5 and C6 (subclavian nerve).Figure 1.: Dermatome distributions determined by different methods: A, Foerster’s map, constructed using stimulation of nerve stumps and observing for vasodilatation (2). B, Head’s diagram, from observation of patients with herpes zoster lesions (3). C, Bonica’s map, developed “on the basis of personal observation and data published by others” (4). D, Keegan’s chart, established on the pattern of hypoalgesia following loss of a single nerve root (5).This case demonstrates that a cervical plexus block can provide analgesia after clavicle ORIF. It remains to be determined whether a CPB could be used as a sole anesthetic for clavicle ORIF in selected patients. Daniel S. Choi, MD, MBA Arthur Atchabahian, MD Anthony R. Brown, MD Department of Anesthesiology; Columbia University College of Physicians and Surgeons; New York, NY; [email protected]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".