Efficacy and safety of clavipectoral fascial plane block for analgesia in clavicle fracture operations: a meta-analysis of randomized controlled trials.

Background: Clavipectoral fascial plane block (CPB) is a novel regional anesthesia technique for clavicle fracture operation that provides effective analgesia while minimizing phrenic nerve involvement. Traditional approaches, including interscalene brachial plexus block (ISBPB) and superficial cervical plexus block (SCPB), are effective but may cause diaphragmatic paralysis and hemodynamic instability. Objectives: To evaluate the analgesic efficacy and safety of CPB compared with ISBPB, SCPB, or placebo in patients undergoing clavicle fracture operation. Data Sources: Electronic databases (PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) were systematically searched from inception to June 2025. Study Eligibility Criteria: Randomized controlled trials comparing CPB with ISBPB, SCPB, or placebo in adults undergoing clavicle fracture operation. Participants and Interventions: Adult patients undergoing clavicle fracture operation who received CPB compared with ISBPB, SCPB, or placebo. Study Appraisal and Synthesis Methods: Meta-analyses were performed using random-effects models (RevMan v5.4.1). Results were expressed as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Evidence certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Six randomized controlled trials including 320 patients were included. CPB significantly reduced postoperative pain at 2 and 6 hours compared with no block and SCPB, with efficacy comparable to ISBPB; no significant differences were observed at 12 or 24 hours. Pooled analysis demonstrated reduced opioid consumption (MD: -2.41; 95% CI: -2.84 to -1.98; p < 0.00001) and prolonged time to first rescue analgesia (MD: 11.06 h vs no block; 9.70 h vs SCPB; 4.19 h vs ISBPB). CPB preserved diaphragmatic excursion (MD: 1.28; 95% CI: 1.05-1.52; p < 0.00001) with stable hemodynamics. The overall certainty of evidence was moderate to low. Limitations: The limited number of trials, small sample sizes, and variability in comparator blocks and outcome reporting may affect the generalizability of the findings. Conclusions: CPB provides effective postoperative analgesia for clavicle fracture operation, reducing pain and opioid consumption while minimizing respiratory complications compared with conventional regional techniques. Larger, high-quality trials are needed to confirm these findings and define its role in multimodal analgesia protocols. Systematic Review Registration Number: PROSPERO registration number: CRD420251068022.