Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial

Introduction In this study, our objective was to compare the lateral sagittal infraclavicular block (LS-ICB) with the costoclavicular infraclavicular block (CC-ICB) for ultrasound (US)-guided infraclavicular brachial plexus block in terms of block dynamics as well as patient and surgeon satisfaction levels. Methods A total of 100 patients, falling under the American Society of Anaesthesiologists (ASA) I-III categories, who were aged 18-65 years and scheduled for elective forearm and hand surgery were enrolled in the study. The patients were randomly allocated to receive a US-guided LS-ICB or US‑guided CC-ICB. The local anesthetic (LA) agent used (20-ml 0.5% bupivacaine) was identical in all subjects. The block performance time and the motor and sensory block onset times were determined to be the primary outcomes. Results The block performance time and the sensory block onset time were shorter in the CC-ICB group compared to the LS-ICB group [median (interquartile range): three (2.5-3.3) vs. two (1.5-2.3) minutes, p: <0.001; five (4.4-6) vs. four (3.8-6) minutes, p = 0.022, respectively]. The number of needle redirections was lower in the CC-ICB [three (2.7-4) vs. two (one to two) times, p: <0.001]. The motor block onset time and the motor-sensory block times were similar in both groups. There were more patients with a complete sensory blockade at five and 10 minutes in the CC-ICB group than in the LS-ICB group (30% vs. 12%, p = 0.027; 66% vs. 26%, p: <0.001, respectively). No complications were observed with regard to both techniques, and patient and surgeon satisfaction levels observed were similar for both groups. Conclusion Based on our findings, the CC approach provided a shorter performance time and a faster onset of the sensory block compared to the LS approach. However, no complications were reported with respect to either technique, and similar patient and surgeon satisfaction levels were observed.