Costoclavicular brachial plexus block for shoulder surgery: a narrative review

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Surgical Procedures

Background:

• The costoclavicular block is a proximal brachial plexus block approach.
• Debate exists regarding its advantages over lateral paracoracoid methods.
• Renewed interest in diaphragm-sparing anesthesia for shoulder surgery highlights the costoclavicular space.

Purpose of the Study:

• To review the costoclavicular block as an alternative to the interscalene block for shoulder surgery.
• To focus on minimizing phrenic nerve involvement.
• To assess its potential for diaphragm-sparing anesthesia.

Main Methods:

• Systematic search of MEDLINE, EMBASE, and Google Scholar databases.
• Inclusion of randomized trials meeting rigorous criteria (prospective registration, blinded assessment, sample size justification).
• Search terms: "costoclavicular block" and "shoulder surgery" up to April 2025.

Main Results:

• Local anesthetic in the costoclavicular space reliably anesthetizes brachial plexus cords.
• High rate of suprascapular nerve blockade achieved.
• The diaphragm was spared in the included studies.

Conclusions:

• Costoclavicular block effectiveness depends on local anesthetic volume and concentration.
• Further research is needed for validation.
• The costoclavicular block is a promising alternative for patients at risk of hemidiaphragmatic paralysis.