Comparison of ultrasound guided costoclavicular brachial plexus block versus supraclavicular brachial plexus block for forearm and hand surgeries for surgical anaesthesia: A prospective randomised clinical study

Abstract

Successful brachial plexus blocks (BPB) rely on proper techniques of nerve localization, needle placement and local anesthetic injection. This study aimed at comparing the efficacy of costoclavicular brachial plexus block versus supraclavicular brachial plexus block for forearm and hand surgeries for providing surgical anesthesia by evaluating the time of onset of sensory and motor blockade, nerve sparing effect and duration of analgesia in both the groups.Fifty patients with ASA physical status 1, 2 and 3 undergoing forearm and hand surgeries were recruited. Fifty patients in Group C (n=25) and Group S (n=25) received 20 ml 0.5% ropivacaine by ultrasound guided costoclavicular and supraclavicular BPB respectively. The primary outcome measure was the time of onset of sensory and motor blockade. Secondary outcome measures included nerve sparing effect and duration of analgesia. Statistical analysis was done with student-t test, unpaired t-test and Fisher exact test. In our study, onset of sensory blockade (8.20 ± 0.58 mins vs 9.72 ± 0.84 mins) and onset of motor blockade (11.72 ± 0.79 mins vs 12.56 ± 0.92 mins) were significantly shorter in group C when compared to group S. We did not find any nerve sparing effect in both the groups unlike other studies. Duration of analgesia (13.14±0.91 hours vs 12.84±0.93 hours) and requirement of rescue analgesics were comparable in both the groups. : We conclude that ultrasound guided costoclavicular BPB has shorter procedural time and rapid onset of sensory-motor blockade compared to supraclavicular BPB.