Ultrasound-Guided Supraclavicular Nerves Block for Acute Pain Management in Clavicular Fractures – a Pragmatic Randomized Trial

Background: /Objectives: This pragmatic randomized controlled trial aimed to evaluate the efficacy of ultrasound-guided supraclavicular nerve (SCLN) block compared to standard pain management in patients with acute displaced clavicle fractures (CF) in an emergency department (ED) setting. Secondary outcomes included the time to first request for analgesics, opioid consumption, and patient satisfaction. Methods: Forty-one patients with acute displaced CF were randomized to receive either a SCLN block (n=19) or routine pain management (n=22). The primary outcome pain intensity was recorded upon admission and at 1, 2, 4, 6, 12, and 24 hours thereafter. The co-primary outcome patient satisfaction was evaluated after 24 hours. Pain medication, adverse reactions and adverse events, were documented for 24 hours. Results: Pain intensity, as measured by the Numeric Rating Scale (NRS), was significantly lower in the SCLN group at all time points within the first 12 hours (p<0.01). After one hour, 68% of patients in the SCLN group reported an NRS of 0-2, compared to 19% in the control group. The time to first request for pain medication was distinctly longer in the SCLN group (9.1 hours vs. 0.7 hours). In two out of 19 patients, the SCLN could not be clearly identified due to challenging ultrasound conditions, necessitating a cervical plexus block. Four patients in the block group reported adverse reactions. Satisfaction with pain management in the ED was significantly higher in the SCLN group (p=0.001), with 85% of patients indicating they would choose the block again in the event of a recurrence. Conclusions: The selective SCLN block provides a highly effective analgesia compared to standard pain management in patients with acute CF, with the most pronounced effect observed within the first 12 hours. Patient acceptance of the procedure was high.