Comparison of costoclavicular and lateral sagittal infraclavicular approaches in ultrasound-guided brachial plexus block

Objectives: Lateral sagittal infraclavicular approach is frequently used because it has less risk of complications and provides rapid and adequate regional anesthesia. Due to the fact that the brachial plexus is deeper in the infraclavicular region and the approach angle is sharper, it can be technically challenging. In this study, we aimed to compare the costoclavicular approach, which is a newly defined approach, with the lateral sagittal infraclavicular brachial plexus block.
Methods: This prospective, randomized, single-blind study was conducted with a total of 43 patients. There were 21 patients in the lateral sagittal infraclavicular approach group (Group L) and 22 patients in the costoclavicular approach group (Group C). A mixture of 10 ml 1% lidocaine with 10 ml 0.25% bupivacaine was given to both groups under the guidance of ultrasonography. Sensory and motor examinations were performed every five minutes for 30 minutes, and the results were recorded.
Results: Sufficient block formation time was 10 (5–30) minutes in Group C and 15 (5–30) minutes in Group L (p=0.010). Sensory and motor block formation times of each nerve (median nerve, radial nerve, ulnar nerve, and musculocutaneous nerve) were found to be shorter in Group C than in Group L (p<0.05).
Conclusion: The costoclavicular approach provides faster regional anesthesia formation than the lateral sagittal infraclavicular approach.