Comparison of Ultrasound-Guided Costoclavicular Brachial Plexus Block Versus Supraclavicular Brachial Plexus Block...

Background Ultrasound-guided brachial plexus block (BPB) is a cornerstone of anesthesia for upper limb surgeries, with supraclavicular (SC) and costoclavicular (CC) approaches being widely used. The CC approach, a modification of the infraclavicular technique, offers a more clustered neural target and potentially faster block onset with fewer complications. Objective This study aims to compare the block characteristics, analgesic efficacy, and safety of ultrasound-guided costoclavicular and supraclavicular brachial plexus blocks in patients undergoing forearm and hand surgery. Methods In this prospective, randomized controlled trial, 64 adult patients (American Society of Anesthesiologists (ASA) I-III) scheduled for elective forearm and hand surgery were randomized into two groups: CC-BPB (n = 32) and SC-BPB (n = 32). Both groups received 20 mL of 0.5% ropivacaine under ultrasound guidance. The primary outcome was the onset time of motor block. Secondary outcomes included onset time of sensory block, block performance time, duration of sensory and motor blockade, duration of analgesia, postoperative pain scores, and complications. The Mann-Whitney U test was used for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. Postoperative VAS scores were analyzed using the Friedman test for repeated measures within each group, followed by Bonferroni-adjusted pairwise comparisons to identify time points with significant differences. The study was registered with the Clinical Trials Registry of India (CTRI/2022/03/041029, dated March 11, 2022). Results The CC-BPB group demonstrated a significantly shorter block performance time (1.53 vs. 1.98 minutes, p < 0.001), faster onset of sensory block (9 vs. 10 minutes, p = 0.001), and quicker onset of motor block (12 vs. 13 minutes, p = 0.001) compared to the SC-BPB group. There were no significant differences between groups in the duration of sensory block, motor block, analgesia, or time to first rescue analgesic request. Postoperative pain scores and complication rates were comparable across groups. Conclusion Ultrasound-guided costoclavicular brachial plexus block offers faster block onset and shorter performance time than the supraclavicular approach while providing equivalent analgesic duration and safety. CC-BPB represents a reliable alternative to SC-BPB for forearm and hand surgery.