Ultrasound-guided Infraclavicular Block Research Articles

A Randomized Controlled Trial to Compare the Efficacy of Single versus Triple Injection Technique for Ultrasound-Guided Infraclavicular Block in Upper Limb Surgeries.

The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region.Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient's satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods. This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups - Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone. The sensory onset time was significantly longer in Group S (11.13 ±1.83 min) than Group T (6.20 ±1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ±0.38 min) when compared to group T (3.44 ±0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups. We concluded that single-point injection method had a shorter performance time and similar total onset time with less procedural complications compared with triple point injection method.

Retrospective Analysis of 0.25% Bupivacaine for Ultrasound-Guided Infraclavicular and Supraclavicular Nerve Blocks in an Ambulatory Surgery Center.

Bupivacaine hydrochloride 0.5% (5 mg/mL) is commonly utilized for analgesia in brachial plexus blocks. We suggest that ultrasound-guided 0.25% (2.5 mg/mL) bupivacaine can be utilized for effective postoperative analgesia to reduce the effective dose. A total of 126 patients underwent ultrasound-guided brachial plexus blocks with 0.25% bupivacaine. The mean duration of analgesia was 21.95 (σ = 3.93) hours with no complications. Patients that received an infraclavicular block (22.56 σ = 4.02) had a significant increase in analgesia compared to supraclavicular blocks (21.09, σ = 3.69) (p = 0.04). These results suggest that further research is warranted for ultrasound-guided 0.25% bupivacaine in brachial plexus nerve blocks.

Randomized comparison between perineural dexamethasone and combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block

BackgroundThis randomized trial compared perineural dexamethasone with combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. We hypothesized that the combination of perineural adjuvants would result in a longer motor block.MethodsFifty patients...

Ultrasound-guided single needle tip placement below axillary artery in the infraclavicular area: A cadaveric study.

The parasagittal ultrasound-guided infraclavicular block (ICB) aims to cover all the elements of brachial plexus for the surgeries at and below the elbow. Our aim was to demonstrate the spread of 20 ml latex in vicinity of brachial plexus cords after injecting posterior to the axillary artery in Thiel embalmed cadavers. A blunt insulated needle was inserted posterior to the axillary artery in a traditional parasagittal infraclavicular in 2 Thiel embalmed cadavers, on both the sides (four specimens). A day later cadaver 1 was dissected and cadaver 2 was frozen at ‒20ºC for 2 weeks and sectioned. Both cadavers were photographed. In cadaver 1, dissection revealed a spread of red latex on the lateral cord extending onto the musculocutaneous nerve, the posterior cord engulfing the radial and axillary nerves distally. In cadaver 2, a cross-section revealed latex engulfed all three cords. Single injection of 20 ml latex aimed posterior to the axillary artery in the parasagittal infraclavicular approach engulfed the posterior, medial and lateral cord in Thiel embalmed cadavers. This needs to be investigated in patients who receive ICB clinically and using contrast studies.

Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study.

ObjectiveUltrasound-guided infraclavicular nerve block (IB) has become a well-established method in several outpatient procedures; however, its use in emergency departments (EDs) remains limited. The aim of this study was to compare procedural sedation and anlagesia (PSA) and IB in the pain management for patients who underwent forearm fracture reduction in the ED.MethodsThis prospective randomized study included 60 patients aged 18 to 65 years, who visited the ED with forearm fractures. They were randomly divided into two groups: Group PSA (n=30) and Group IB (n=30). The pain scores of patients were evaluated before and during the procedure with the visual analog scale. Complications and patient and operator satisfaction levels were recorded.ResultsThere was no difference between the two groups in terms of demographic characteristics. The median (interquartile range) pain scores observed during the procedures were significantly higher in Group PSA than in Group IB (4 [4–6] vs. 2 [0–2], respectively; P<0.001). Patient and operator satisfaction levels were significantly higher in Group IB (P<0.001). Oxygen desaturation was statistically higher in Group PSA than in Group IB (40.00% vs. 3.33%, respectively; P=0.002).ConclusionIB was an effective alternative for reducing pain and increasing patient satisfaction in ED patients undergoing forearm fracture reduction.

Ultrasound-Guided Infraclavicular Block in a Patient with Huntington’s Disease: Case Report

Ultrasound-Guided Infraclavicular Block in a Patient with Huntington’s Disease: Case Report

Comparison of the lateral sagittal and costoclavicular approaches for ultrasound-guided infraclavicular block in pediatric patients: a prospective randomized study

BackgroundThe lateral sagittal brachial plexus block is the most used method for pediatric upper extremity surgery, whereas the applications of costoclavicular brachial plexus block are limited. This study aimed to compare the lateral sagittal and costoclavicular approaches for the ultrasound-guided infraclavicular block in pediatric patients. MethodsSixty pediatric patients aged 5–15 years undergoing hand or forearm surgery were randomly assigned to two groups. Group LS (n = 30) received ultrasound-guided lateral sagittal block, and Group CC (n = 30) received ultrasound-guided costoclavicular block. The block performing time, needling time, imaging time, needle visibility, number of passes, sensorial/motor block time, and postoperative pain scores were evaluated. ResultsThe needling time (82.90 ± 28.17 seconds vs. 64.77 ± 28.11 seconds respectively, p = 0.004) and total block performance time (109.53 ± 29.75 seconds vs. 89.70 ± 29.98 seconds respectively, p = 0.005) were significantly longer in Group LS than in Group CC. However, there was no significant difference between the groups in imaging time, needle visibility, number of passes, sensorial/motor block time, and postoperative pain scores (p > 0.05). ConclusionsCostoclavicular and lateral sagittal brachial plexus blocks resulted in similar anesthetics effects. Moreover, the costoclavicular method can be a better alternative to lateral sagittal as it has a shorter block performance time.

Does local anesthetic temperature affect the onset and duration of ultrasound-guided infraclavicular brachial plexus nerve block?: a randomized clinical trial

BackgroundInfraclavicular brachial plexus nerve block is a commonly performed anesthesiology technique in the upper extremity. Local anesthetics may be administered at different temperatures for both neuraxial and peripheral nerve blocks. We aimed to evaluate the effects of the temperature of the local anesthetic at the time of administration on the onset and duration of sensory and motor blocks in infraclavicular brachial plexus nerve block. MethodsA total of 80 patients undergoing elective upper extremity surgery were randomly assigned to one of the following groups using a computer-based randomization software; low temperature (4 °C) (Group L, n = 26), room temperature (25 °C) (Group R, n = 27) and warmed (37 °C) (Group W, n = 27). A 1:1 mixture of 2% lidocaine and 0.5% bupivacaine was used as local anesthetic. Infraclavicular brachial plexus nerve block was performed under ultrasound guidance in all patients preoperatively. The onset and duration of sensory and motor blocks were recorded. ResultsEach group had different onset of motor (p < 0.001) and sensory (p < 0.001) blocks. The duration of motor block was similar between groups (p = 221). However, a significant difference was found in the duration of sensory block between group L (399.1 ± 40.8 min) and group R (379.6 ± 27.6 min) (p = 0.043). There was no complication related to nerve block procedure. ConclusionsThe administration of the local anesthetic at lower temperatures may prolong the onset of both motor and sensory blocks in infraclavicular brachial plexus nerve block.

Evaluation of the effects of ultrasound-guided infraclavicular nerve block on postoperative pain in pediatric supracondylar fracture surgery

Background/Aim: Ultrasound-guided upper and lower extremity nerve blocks offer significant advantages in adult patients. However, the effectiveness of these advantages in children is being investigated. The aim of this study was to evaluate postoperative pain scores of single-injection infraclavicular nerve block in pediatric patients who underwent supracondylar surgery. Methods: Forty-one patients who underwent supracondylar surgery between December 2016 and December 2017, with either general anesthesia (GA, n=19) or ultrasound-guided infraclavicular block (ICB, n=22) were included in this retrospective cohort study. Postoperative visual analogue scale (VAS) pain scores at the 30th min, 2nd, 6th, 12th, and 24th hours, the total amount of pethidine and paracetamol administered, and time until the first analgesia requirement were evaluated. Results: The demographic characteristics of the patients were similar (p>0.05). The VAS scores and total amount of consumed pethidine and paracetamol were lower in the ICB group in the first 12 hours than in the GA group, but the opposite was true at the 24th hour (P<0.001). The first analgesia requirement time was much longer in the ICB group than in the GA group (P<0.001). The two groups were similar in terms of complications (P<0.05). Conclusion: Ultrasound-guided infraclavicular block could be a useful option for postoperative analgesia control in patients undergoing supracondylar surgery.

Sedoanalgesia Versus Infraclavicular Block for Closed Reduction of Pediatric Forearm Fracture in Emergency Department: Prospective Randomized Study.

Procedural sedoanalgesia is commonly used in pediatric patients in the emergency department (ED) for interventional procedures, diagnosis, and treatment. However, this method causes serious systemic complications, such as respiratory and cardiac depression. To minimize these complications, ultrasound-guided regional anesthesia methods have been used in recent years. We aimed to compare the use of procedural sedoanalgesia (PSA) and infraclavicular block (ICB) in the pain management of pediatric patients who underwent closed reductions of forearm fractures. This prospective, randomized, clinical study included patients aged 3 to 15 years who presented to the ED with forearm fractures. The patients were divided into 2 groups: the procedural sedoanalgesia group (group PSA, n = 30) and ultrasound-guided ICB group (group ICB, n = 30). Pain scores of the patients were evaluated using the Wong-Baker FACES Scale before and during the procedure. Pain scores and parental and operator satisfaction were compared between the groups. There was no statistical significance in terms of demographic data. The pain scores observed during the procedures were significantly higher in the group PSA than in the group ICB (3.07 ± 1.55 vs 0.47 ± 0.86, respectively; P < 0.001). The parental and operator satisfaction of the ICB group was significantly higher than that of the PSA group (P < 0.001). Ultrasound-guided ICB is a safe and effective method in the management of pain during closed reduction of forearm fracture in pediatric patients in EDs. It can be used safely in emergency rooms and has a high level of both parental and operator satisfaction.

A review of the anatomy and a step-by-step visual guide to performing an ultrasound-guided infraclavicular brachial plexus block

Background: The aim of this description is to provide step-by-step guidelines for performing an ultrasound guided infraclavicular brachial plexus nerve block. Methods: The brachial plexus in the infraclavicular fossa of sixty healthy volunteers was scanned in the horizontal/transverse plane. The relevant regional anatomy was studied to identify the muscular and vascular structures seen on the ultrasound screen. Results: The entire process was documented and a standard, step-by-step guide to performing ultrasound guided vertical infraclavicular brachial plexus blocks was developed. Conclusion: The development of high-resolution ultrasound guidance has allowed for the direct visualisation of the brachial plexus when performing nerve blocks. Ultrasound-guided infraclavicular brachial plexus nerve blocks are becoming more popular. This description aimed to provide step-by-step guidelines on how to perform this block safely and efficiently.

Effect of Added Alpha 2 Agonists with Local Anaesthetic in Infraclavicular Brachial Plexus Block: A Comparative Study between Dexmedetomidine and Clonidine.

Background:Many adjuvant drugs are added with local anesthetics to increase the quality of regional blocks.Aim:To compare the effects of dexmedetomidine and clonidine added to bupivacaine in infraclavicular brachial plexus block in prolonging the duration of analgesia in patients undergoing orthopedic surgery of forearm or hand and also to compare the duration of sensory and motor block, sedation, and hemodynamic changes like bradycardia and hypotension in two groups.Settings and Design:This was an observational study conducted in a tertiary care hospital.Materials and Methods:A study was conducted among 60 patients admitted for elective upper limb surgeries under ultrasound-guided infraclavicular block. Patients who received bupivacaine 0.5% (20 mL) + Clonidine 1 μg.kg−1 were classified as Group A and those received bupivacaine 0.5% (20 mL) + dexmedetomidine 1 μg.kg−1 were classified as Group B.Statistical Analysis:Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 25.Results:Duration of analgesia was significantly higher in Group B as compared to Group A (mean + standard deviation = 764 ± 17.573 min vs. 526 ± 9.958 min, respectively, P = 0.001). The mean time for onset of a sensory block as well as motor block was significantly less in Group B when compared to Group A (P = 0.001). The mean duration of both sensory block and motor block was higher in Group B as compared to Group A (P = 0.001).Conclusions:The dexmedetomidine group (Group B) provides a quicker and prolonged analgesic action without major adverse effects.

The Effects of Magnesium Sulfate with Lidocaine for Infraclavicular Brachial Plexus Block for Upper Extremity Surgeries.

Background An addition of analgesic to anesthetic agents is likely to increase the effects of anesthesia and reduce associated adverse outcomes. Several adjuvants are studied in this regard. The aim of this study is to investigate the effects of adding a magnesium adjunct to lidocaine for the induction of infraclavicular block. Methods Patients referred to Shohada Ashayer Hospital, Khorramabad, for wrist and hand surgery were enrolled in this study. The intervention/case group included patients who received 18 mL lidocaine (2%) + 2 mL magnesium sulfate (50%), 10 mL normal saline; control group: 18 mL lidocaine (2%) + 12 mL of normal saline. After the induction of ultrasound-guided infraclavicular block, parameters such as duration of reach with respect to complete sensory and motor block, hemodynamic parameters (hypotension and bradycardia), and postoperative pain, using visual analogue scale criteria, were measured. The obtained data were analyzed using a Bayesian path analysis model. Results A total of 30 patients were included in each group. In the case group, sensory and motor block was achieved for 12.136 ± 4.96 and 13 ± 3.589 minutes more than those in the control group. The duration of sedation and immobilization was 2.57 ± 0.764 minute and 4.66 ± 0.909 minutes lengthier in the case group. Regarding the hemodynamic parameters, blood pressure was 0.217 ± 5.031 and 1.59 ± 5.14 units lower in the case group, immediately following the block and the surgery. Similarly, heart rate was 0.776 ± 4.548 and 0.39 ± 3.987 units higher in the case group, after 30 minutes and 2 hours of the procedure. A decrease in the pain was seen at 8, 10, and 12 hours after the surgery, as compared with the control group. An addition of magnesium to lidocaine for infraclavicular block resulted in a significantly longer sedation and immobilization period and decreased postoperative pain at 12 hours. Conclusion Heart rate and blood pressure did not decrease significantly in the case group. It can be concluded that addition of magnesium sulfate to lidocaine can produce better anesthetic and analgesic outcomes with low-to-no adverse effects.

Use of a curved needle to facilitate lateral sagittal infraclavicular block performance: a randomized clinical trial

Failed needle-tip positioning in an ultrasound-guided infraclavicular block can be due to improper needle insertion point and steep needle insertion angle. Needle pre-curving enables the user to pass the needle with different curved trajectories on approaching the brachial plexus. Aim of the study was to compare curved and non-curved needles as regards the time needed to perform the lateral sagittal infra-clavicular block. Sixty-nine patients undergoing surgery distal to the elbow were randomly allocated to two groups: group A (n = 35), which received ultrasound-guided infraclavicular block using the curved needle; and group B (n = 34), which received the infraclavicular block using the non-curved needle. The primary outcome measure was the time needed to perform the infraclavicular block. Anesthetist's experience with the curved vs. non-curved needle was noted. Mean (SD) recognition time (120 ± 48 vs. 179 ± 72s, P = 0.0002) and injection time (54 ± 23 vs. 88 ± 36s, P = 0.0001) were shorter in group A compared to group B. Median (IQR) procedure pain score was less in group A 2 (1-2) than in group B 2 (2-3); P = 0.001. Median (IQR) satisfaction score was higher with regards to the curved needle 4 (4-5) than non-curved needle 3 (3-4) in performing infraclavicular blockade; P = 0.001. The use of a curved needle reduces the time required to perform the lateral sagittal infraclavicular block. The curved needle provides less procedure pain and higher satisfaction levels among anesthetists than the non-curved needle. The trial was registered (04/26/2016) with the ClinicalTrials.gov ID: NCT02799576. Approval Number: #2543. Board Name: Research Ethics Committee. Board Affiliation: Suez Canal University, Faculty of Medicine, Suez Canal University hospital, Ismailia, Egypt, 41522.

Randomized comparison between perineural dexamethasone and dexmedetomidine for ultrasound-guided infraclavicular block

BackgroundThis randomized trial compared perineural dexamethasone (5 mg) and dexmedetomidine (100 µg) for ultrasound-guided infraclavicular brachial plexus block. We hypothesized that both adjuvants would result in similar durations of motor...

Retrospective Analysis of Ultrasound-Guided Infraclavicular Block: Effect of Experience of Anesthesiologists on Volume of Local Anesthetic Administered.

Performing a block under ultrasound guidance effectively requires skill; however, inexperienced anesthesiologists often use high-dose LA to ensure success. We aimed to share our experience with the ultrasound-guided infraclavicular brachial plexus block (USGICB) for upper extremity surgeries and to determine changes in failure rate and local anesthetic dose administered with gaining adequate experience. With approval from the local ethics committee, a retrospective review of records of 2953 patients who underwent USGICB between November 2011 and March 2015 was performed for evaluating the following data: age, sex, height, weight, operation type, American Society of Anesthesiologists physical status score, local anesthetic volume, complications, and success of USGICB. The patients were divided into 4 groups of 10 months each from November 2011 to March 2015: first 10-month period, 628 cases (group I); second 10-month period, 672 (group II); third 10-month period, 720 (group III); and the fourth 10-month period, 933 cases (group IV). Nine anesthesiologists with the same baseline experience in USG performed the blocks. During the initial period, when anesthesiologists had insufficient experience, local anesthetic (LA) dose, success rate, failed blocks, and complications were investigated. The LA volume administered in group I (33.7 ± 4.2 ml) was significantly higher than that in groups II, III, and IV (p < 0.05). Although a reduction in LA volume administered with increasing anesthesiologist experience was not statistically significant, a volume reduction of over 30 ml was observed in groups II, III, and IV compared with group I. Furthermore, in group I, failure rate (3.2%) was higher than that in groups II, III, and IV (p < 0.05). We concluded that sonographic guidance ensures a high success rate and that increased experience of anesthesiologists is associated with reduced complications and failure rate of blocks, in addition to prevention of LA overdose.

Ultrasonografi Kılavuzluğunda İnfraklaviküler Blok ile Üst Ekstremite Ortopedi Cerrahisi Geçiren Hastalarda Midazolam ve Deksmedetomidin ile Sedasyonun Periferik Sinir Bloğu Üzerine Etkilerinin Karşılaştırılması

Objective: Sedation is an important step of regional anesthesia, the effects of sedative agents on nerve block characteristics are often subjects of scientific researches. In our study, we aimed to compare the effects of dexmedetomidine and midazolam sedation on sensory and motor onset and termination time after infraclavicular nerve block. Material and Methods: After local ethics committee approval and patients written informed consents were obtained, 60 patients between the ages of 18-65 years, with an American Society of Anesthesiologists (ASA) classification I-II who received infraclavicular nerve block randomized into two groups. Group D received 0.8 μg/kg bolus continued with 0.2-0.7 μg/kg/h of maintenance dose of dexmedetomidine group M received 0.05mg/kg bolus continued with 0.02-0.2 mg/kg/h of maintenance dose of midazolam. The patient's demographic data heart rate pulse, mean arterial pressure, sensory and motor block onset and termination time were analyzed. Results: Heart rate and mean arterial pressure were lower in dexmedetomidine group. Sensory (Group D: 8.6±2.4 Group M: 16.2±1.8) and motor block onset time (Group D: 14.2±1.6, Group M: 21.4±2.3) was shorter in dexmedetomidine group. Sensory (Group D: 715.4±41.1 min Group M: 518.1±44.2 min) and motor block termination time (Group D: 613.6±38.1 min Group M: 421.3±37.2 min) were longer in dexmedetomidine group. Conclusion: The use of dexmedetomidine for sedation on patients who received ultrasound-guided infraclavicular block for upper extremity surgeries resulted earlier onset time to sensory and motor block and prolonged sensory and motor block termination time.

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Background: Opioids added to local anesthetics for peripheral nerve blocks may intensify analgesia and prolong analgesic and sensorial block duration. These agents may also cause potentiation and prolongation of motor block. Objective: This study compared the postoperative effects of 30 mL of 0.25% bupivacaine +50 mcg fentanyl and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl solutions for the ultrasound-guided infraclavicular block in patients undergoing elbow and forearm surgery. Methods: In this randomized double-blind study, thirty-six patients with risk of ASA class I-III were randomly allocated into 2 randomized groups. Ultrasound-guided infraclavicular blocks with 30 mL of 0.25% bupivacaine + 50 mcg fentanyl for group 1 and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl for group 2 were performed before patients emerged from general anesthesia. After surgery, pain levels at rest and during movement were evaluated using the 10-cm visual analog scale (VAS) at recovery room admission, at the 15th and 30th minutes in the recovery room, and at the 2nd, 6th, 12th and 24th hours postoperatively. Both morphine and rescue analgesic requirements were recorded. Sensorial and motor block durations, patient satisfaction, and complications related to the infraclavicular block were recorded. Results: In both groups, no significant difference in VAS pain scores, total morphine and total rescue analgesic requirements, duration of sensorial and motor block, or patient satisfaction were observed. None of the patients experienced any complications. Conclusion: The mixtures of 0.25% bupivacaine + 50 mcg fentanyl and 0.25% bupivacaine + 100 mcg fentanyl showed similar postoperative effects.

Case Report: Ultrasound-Guided Infraclavicular Brachial Plexus Block for a Case with Posterior Elbow Dislocation

BackgroundThe interest in regional anesthesia procedures for the management of upper-extremity emergencies has increased. Toward that end, supraclavicular, interscalene, or infraclavicular approaches, with or without ultrasound guidance, are used for brachial plexus nerve blocks. Although many studies have reported on the use of ultrasound-guided supraclavicular and interscalene brachial plexus blocks for upper-extremity dislocations, very few studies have reported on the use of ultrasound-guided infraclavicular brachial plexus blocks. Case ReportWe present an adult patient with posterior elbow dislocation that is treated with reduction after applying an ultrasound-guided infraclavicular brachial plexus block. Additionally, we describe the infraclavicular block in detail and demonstrate the technique using images. Why Should an Emergency Physician Be Aware of This?Based on our experience, the ultrasound-guided infraclavicular block is a fast, safe, and efficient anesthesia technique that can be an excellent alternative to sedoanalgesia and other brachial plexus blocks for the management of elbow dislocations in the emergency department.

Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion

Abstract Introduction Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index. Objective To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes. Materials and methods Description of the technique and administration of 20 ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index. Results In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching the interscalenic space as far as the secondary trunks. Successful blocks were observed in 91% of patients after 25 min. All the parameters reflecting sympathetic block increased significantly. The humeral artery blood flow showed an increase from 108 ± 86 to 188 ± 141 ml/min ( p = 0.05), skin temperature from 32.1 ± 2 to 32.8 ± 9 °C ( p = 0.03) and perfusion index from 4 ± 3 to 9 ± 5 ( p = 0.003). Conclusions The medial approach of the ultrasound-guided costoclavicular block is anatomically feasible, with high clinical effectiveness using 20 ml of 1.5% mepivacaine. The sympathetic block can be evaluated with all three parameters studied.