Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: A systematic...

Hemidiaphragmatic paralysis (HDP) may impair the pulmonary function, which could be a substantial issue in individuals suffering from underlying lung disease or compromised lung function. Hence, several diaphragm-sparing methods have been used to avoid HDP after brachial plexus blocks. Although various studies have reported a lower incidence of HDP with costoclavicular block (CCB) compared to supraclavicular block (SCB), a systematic review and meta-analysis to confirm the potential benefits has not been done. Therefore, we analyzed the association of HDP with CCB and SCB.

The incidence of HDP was the primary outcome, and the change in diaphragmatic thickness fraction (DTF), change in hemidiaphragm excursion, and change in peak expiratory flow rate (PEFR) were the secondary outcomes. Six full texts of the articles were selected in the systematic review and meta-analysis of 263 patients who received CCB and 269 patients who received SCB.

The incidence of HDP after CCB was significantly lower than that associated with SCB (16 vs. 115), risk difference: -0.41 (95% confidence interval [CI]: -0.48 to -0.34; P < 0.001) without heterogeneity (I² = 0%). Contractility was more preserved in CCB, and hence, thickness of the diaphragm was more during inspiration. The mean difference in DTF% between the two groups was 33.58 (95% CI: 20.68-46.48). PEFR was more preserved in CCB when compared to SCB: standardized mean difference: 0.46 (95% CI: -0.20-0.72; P = 0.24, I ² = 29%; fixed effect model).

The incidence of HDP after CCB was significantly lesser than that after SCB.