Ultrasound-Guided Medial Versus Lateral Approach of the Costoclavicular Block: A Prospective Randomized Study

Costoclavicular block is a regional anesthesia technique that involves targeting the brachial plexus in the proximal infraclavicular fossa. It can be applied via a lateral or medial approach. This randomized study aimed to compare the anesthetic efficacy and block dynamics of both approaches.

Eighty-eight patients undergoing upper extremity surgery were randomly assigned to either the medial (Group M, n = 44) or lateral (Group L, n = 44) approach. The procedures were performed under ultrasound guidance. Both groups received 20 mL of local anesthetic (10 mL of 2% lidocaine and 10 mL of 0.5% bupivacaine) via an in-plane technique. In Group M, the needle was directed medially to laterally, and in Group L, it was directed laterally to medially, with the anesthetic injected at the three-cord midpoint. Block dynamics and complications were recorded. A blinded researcher assessed sensory and motor block onset every 5 minutes for 30 minutes. Surgeon-perceived anesthesia quality, additional analgesia needs, and patient satisfaction were recorded.

Surgical duration, procedure type, and anesthesia onset time were similar (Group M: 5.79 ± 2.14 min; Group L: 5.56 ± 1.93 min). The ultrasound scanning time was longer in Group L, but the total block performance time was not significantly different (P > 0.05). In Group M, the needle-pleura distance was greater, and the motor block onset time was shorter (P < 0.05). No significant differences were found in terms of complications, additional analgesia needs, and patient and surgeon satisfaction (P > 0.05).

The medial approach demonstrates anesthetic efficacy comparable to that of the lateral approach.