Ultrasound-Guided Costoclavicular vs. Axillary Brachial Plexus Block for Forearm, Wrist, and Hand Surgeries: A Prospective Randomized Comparative Study

Abstract

Brachial plexus blocks are widely used for forearm, wrist, and hand surgeries to provide effective regional anesthesia. The costoclavicular and axillary approaches are two commonly used techniques for brachial plexus blocks, but their relative efficacy, onset time, and safety profile remain subjects of clinical interest. This study aims to compare the ultrasound-guided costoclavicular and axillary brachial plexus block techniques in terms of anesthetic effectiveness, onset time, block success rate, and complication rates in patients undergoing forearm, wrist, and hand surgeries. In this prospective randomized comparative study, 120 patients scheduled for elective forearm, wrist, or hand surgery were randomly assigned to receive either a costoclavicular or an axillary brachial plexus block under ultrasound guidance. The primary outcome was the onset time of the sensory and motor blockade. Secondary outcomes included block success rate, duration of analgesia, total anesthetic volume used, and complications such as vascular puncture and nerve injury. The costoclavicular approach demonstrated a significantly faster onset of sensory and motor blockade compared to the axillary approach. The success rate of the block was also higher in the costoclavicular group. However, no significant differences were observed in the duration of postoperative analgesia between the two techniques. The incidence of vascular puncture was slightly higher in the axillary group. Ultrasound-guided costoclavicular brachial plexus block offers a faster onset and higher success rate compared to the axillary approach for forearm, wrist, and hand surgeries, making it a preferable choice in clinical practice. Further studies are needed to confirm its long-term safety and efficacy.
Brachial plexus block, costoclavicular block, axillary block, ultrasound-guided regional anesthesia, forearm surgery, wrist surgery, hand surgery, comparative study.