A Randomized Double-Blind Study Comparing the Anaesthetic Efficacy of Costoclavicular and Supraclavicular Brachial Plexus Blocks in Forearm Surgery

Abstract

Introduction: Brachial plexus blocks are well established as the primary anesthetic method in upper extremity surgeries. While the conventional supraclavicular block (SCB) is effective, it carries inherent risks of vascular puncture, ulnar nerve sparing, and Horner's syndrome. The costoclavicular brachial plexus block (CCB) is a novel modification of the infraclavicular approach where all three cords are clustered together in a compact topography lateral to the axillary artery, allowing for a single-injection technique. The study detailed in paper final documents evaluated and compared the anesthetic efficacy, onset times, and complication rates of ultrasound-guided CCB versus conventional SCB in patients undergoing forearm and hand surgeries.
Methods: This double-blind, randomized clinical study evaluated 60 patients aged 18 to 65 years (ASA grade I and II) scheduled for elective forearm and hand surgeries. Patients were randomly assigned into two equal groups of 30: Group CCB and Group SCB. Both groups received a local anesthetic mixture of 10 ml Lignocaine with adrenaline 2%, 10 ml Bupivacaine 0.5%, and 4 mg Dexamethasone. Data regarding block performance time, sensory and motor blockade onset times, block success rate, duration of postoperative analgesia, and adverse events were collected and monitored. Data analysis was conducted using SPSS version 24.0.
Results:The study findings showed that the block performance time was significantly shorter in Group CCB compared to Group SCB (7.61 ± 2.24 mins vs 9.12 ± 1.70 mins, p = 0.0047). Sensory onset (8.48 ± 1.29 mins vs 10.62 ± 0.68 mins, p < 0.0001) and motor onset (11.25 ± 1.04 mins vs 12.74 ± 0.94 mins, p < 0.0001) were achieved significantly earlier in the CCB group. The block success rate was 100% in Group CCB compared to 86.67% in Group SCB (p = 0.0366), with ulnar nerve sparing accounting for all 4 failed cases in the SCB group. Furthermore, Group CCB demonstrated a significantly longer duration of postoperative analgesia (11.11 ± 1.13 hours vs 9.79 ± 1.33 hours, p = 0.0001) and required fewer rescue analgesic doses. Complications in the SCB group included vascular puncture (10%) and transient Horner's syndrome (13.33%), whereas no complications were observed in the CCB group.
Conclusion: The study concluded that ultrasound-guided costoclavicular brachial plexus block provides a faster performance time, more rapid sensory and motor onset, higher procedural success, and prolonged postoperative analgesia compared to the conventional supraclavicular approach. It serves as a highly reliable and safe alternative for surgical anesthesia in forearm and hand procedures.