Background: Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis. Case report: A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period. Conclusion: Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.

Background/Objectives: Physical exercise (PE) is essential in promoting health and quality of life and protecting against chronic diseases. Health professionals are identified as key figures in promoting and prescribing PE, yet various factors may impact this during consultations. This study aims to assess Portuguese specialist physicians’ understanding of the importance of PE prescriptions. It will also investigate the approaches they utilize in promoting and prescribing PE, their knowledge of incorporating this practice into their consultations, and the major facilitators or barriers to prescription. Methods: A cross-sectional observational study was conducted using a validated questionnaire distributed via email by the Centre Regional Section of the Portuguese Medical Association to physicians. The data were analyzed using descriptive and inferential statistics. Results: In total, 414 responses were collected, with participants representing different medical specialties. The participants were primarily women (62.8%) with a mean age of 49.9 ± 14.9 years. While 85.5% of physicians promoted and prescribed PE, recognizing its cardiovascular and metabolic health benefits, only 24.0% received specific training, and 73.7% were unaware of relevant guidelines. Older male physicians (over 60 years old) expressed more confidence in PE prescriptions, while younger ones were more familiar with electronic prescribing tools. Identified barriers included patient compliance (42.3%), a lack of accessible PE resources (18.4%), and limited consultation time (17.4%). Most physicians (64.4%) relied on oral counseling for prescriptions. Conclusions: Most Portuguese specialist doctors recognize the benefits of PE prescriptions. However, barriers like inadequate training and patient compliance hinder PE implementation. Enhanced training and resources are vital for effectively integrating PE into clinical practice.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Background and Aims In thoracic trauma with pneumothorax, mechanical ventilation should be avoided whenever possible. Regional anesthesia can be an attractive alternative anesthetic approach in this setting. In clavicular surgery, regional anesthesia requires the block of various nerves that conduct nociceptive information of the skin over the incision area and the clavicula periosteum. Methods A 66 year-old male patient was scheduled for open reduction and internal fixation of the right clavicle. He had a closed, displaced fracture in the middle third shaft of the right clavicle (car crash). The pre-anesthetic patient assessment revealed a significant medical past: ischemic stroke in 2016 and controlled arterial hypertension. The patient also presented a small right hemopneumothorax and bilateral rib fractures. The anesthesia plan included a regional anesthesia combined with dexmedetomidine perfusion. The regional anesthesia of the surgical field was achieved with a superficial cervical plexus block, combined with a clavipectoral fascial plane block. Anesthesia distribution of peripheral’s nerves blocks: superficial cervical plexus block and clavipectoral fascia plane block Results The surgery lasted 2 hours, during which the patient remained comfortable, with total sensory block. Towards the end of the surgery, acetaminophen and parecoxib were administered. In the post-anesthesia care unit, the patient complained of no pain and no rescue analgesia was needed. During the first 24h post-surgery, the pain remained controlled with conventional intravenous analgesia with acetaminophen and non- steroidal anti-inflammatory drugs. Conclusions In our case report, we decided to combine clavipectoral fascial plane block and superficial cervical plexus block. Together, these blocks can provide complete sensory anesthesia for surgical procedures involving the clavicle, providing a safe and reliable alternative to general anesthesia.