Ultrasound-guided costoclavicular vs. axillary brachial plexus block: A randomized clinical study

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Ultrasound-Guided Procedures

Background:

• The brachial plexus is more compact at the costoclavicular space (CCS) than in the axilla.
• This anatomical difference may influence brachial plexus block (BPB) efficacy.

Purpose of the Study:

• To test the hypothesis that BPB at the CCS leads to faster onset than the axillary approach.
• To compare block onset time, performance time, and success rates between CCS and axillary BPB.

Main Methods:

• Fifty patients undergoing surgeries below the mid-arm received ultrasound-guided BPB.
• Patients were randomized to either CCS or axillary approach.
• A standardized local anesthetic mixture was administered, and block onset, performance time, and success were recorded by a blinded observer.

Main Results:

• Mean onset times were similar between the costoclavicular (CC) and axillary (AX) groups (12.0 ± 3.2 min vs. 11.2 ± 2.9 min, P=0.367).
• Block performance time was significantly shorter in the CC group compared to the AX group (5.3 ± 1.9 min vs. 8.0 ± 3 min, P<0.05).
• Success rates were comparable, with no significant intergroup differences in complications.

Conclusions:

• Ultrasound-guided BPB at the CCS and axillary approach yield similar block onset times.
• The CCS approach is more efficient, demonstrating a reduced block performance time.
• Both techniques are equally effective and safe for surgeries below the mid-arm.