Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial

Abstract

In this study, our objective was to compare the lateral sagittal infraclavicular block (LS-ICB) with the costoclavicular infraclavicular block (CC-ICB) for ultrasound (US)-guided infraclavicular brachial plexus block in terms of block dynamics as well as patient and surgeon satisfaction levels. MethodsA total of 100 patients, falling under the American Society of Anaesthesiologists (ASA) I-III categories, who were aged 18-65 years and scheduled for elective forearm and hand surgery were enrolled in the study. The patients were randomly allocated to receive a US-guided LS-ICB or US-guided CC-ICB. The local anesthetic (LA) agent used (20-ml 0.5% bupivacaine) was identical in all subjects. The block performance time and the motor and sensory block onset times were determined to be the primary outcomes. ResultsThe block performance time and the sensory block onset time were shorter in the CC-ICB group compared to the LS-ICB group [median (interquartile range): three (2.5-3.3) vs. two (1.5-2.3) minutes, p: <0.001; five (4.4-6) vs. four (3.8-6) minutes, p = 0.022, respectively]. The number of needle redirections was lower in the CC-ICB [three (2.7-4) vs. two (one to two) times, p: <0.001]. The motor block onset time and the motor-sensory block times were similar in both groups. There were more patients with a complete sensory blockade at five and 10 minutes in the CC-ICB group than in the LS-ICB group (30% vs. 12%, p = 0.027; 66% vs. 26%, p: <0.001, respectively). No complications were observed with regard to both techniques, and patient and surgeon satisfaction levels observed were similar for both groups. ConclusionBased on our findings, the CC approach provided a shorter performance time and a faster onset of the sensory block compared to the LS approach. However, no complications were reported with respect to either technique, and similar patient and surgeon satisfaction levels were observed.

Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis

“…Among the 414 patients in the RCTs, 203 and 211 patients underwent CCB and other BPB techniques, respectively. The other BPB techniques included supraclavicular block (n = 3) [ 6 , 7 , 29 ], interscalene block (n = 1) [ 27 ], lateral sagittal block (n = 1) [ 26 ], superior trunk block (n = 1) [ 28 ], and paracoracoid block (n = 1) [ 8 ]. Table 1 shows detailed information regarding the seven included studies.…”

“…The incidence of HDP was significantly lower in the CCB group than in the other BPB group (5.9% vs. 31.3%, six studies; RR: 0.21, 95% CI [0.12, 0.36], P < 0.001, I 2 = 47%; fixed-effect model) ( Fig. 4 ) [ 6 – 8 , 26 – 28 ]. The re-estimated RR in the sensitivity analysis retained statistical significance ( Supplementary Fig.…”

Infraclavicular versus costoclavicular approaches to ultrasound-guided brachial plexus block: a systematic review and meta-analysis

“… 13 , 14 , 15 , 16 One trial used the pinprick test, adopting the following scale: 0 = no sensation, 1 = pinprick present. 17 …”

“…Motor block assessment was conducted through movement evaluation in four RCTs 13 , 14 , 15 , 16 (2 = normal, 1 = paresis, 0 = paralysis), whereas one trial 17 employed the Lovett rating scale (6 = normal muscular force, 5 = slightly reduced muscular force, 4 = pronounced reduction in muscular force, 3 = slightly impaired mobility, 2 = pronounced mobility impairment, 1 = almost complete paralysis, 0 = complete paralysis). Performance time was defined differently in the studies.…”

“…Performance time was defined differently in the studies. In one RCT, 13 it was determined as the sum of imaging and needling times, whereas in the other RCTs, 14 , 15 , 16 , 17 it referred to the duration from local infiltration to the completion of local anesthetic injection.…”