Combined Regional Analgesia for Complex Unilateral Clavicular and Thoracic Trauma Undergoing Clavicle Fixation: A...

Patients with simultaneous clavicular and ipsilateral thoracic trauma, including multiple rib fractures and traumatic pneumothorax, present a complex perioperative analgesic challenge. Effective pain control must be balanced against the preservation of respiratory function while minimizing opioid-related adverse effects. Individual regional anesthesia techniques for clavicle surgery and rib fracture analgesia are well established; however, selecting an appropriate multimodal analgesic strategy for patients with combined injuries requires careful clinical judgment. We report the case of a 51-year-old man who sustained a displaced right midshaft clavicle fracture, multiple right-sided rib fractures, a comminuted scapular fracture, and a small traumatic pneumothorax following blunt chest trauma. The patient underwent open reduction and internal fixation (ORIF) of the clavicle under general anesthesia. After securing the airway with endotracheal intubation, an ultrasound-guided right erector spinae plane (ESP) block using 20 mL of 0.25% bupivacaine was performed to provide analgesia for the rib fractures and chest wall injury, followed by an ultrasound-guided right interscalene block using 20 mL of 0.25% bupivacaine for clavicular surgical analgesia as part of a multimodal analgesic strategy. The intraoperative course remained hemodynamically stable without significant fluctuations in heart rate or blood pressure. Postoperatively, the patient experienced excellent analgesia without immediate rescue opioid requirements, maintained satisfactory respiratory function, and was able to perform deep breathing, effective coughing, and early mobilization. This case highlights the importance of individualized perioperative anesthetic planning in patients with complex unilateral clavicular and thoracic trauma. Although the regional anesthesia techniques employed are well established, their combined application should be guided by the injury pattern, respiratory considerations, and the need to provide effective targeted analgesia for distinct anatomical regions.