Comparison between single and double injection ultrasound-guided costoclavicular block for below elbow surgeries – a prospective randomized controlled study

Authors: Shivanika selvam, Rajesh Kumar Kodali V, Ramkumar Dhanasekaran, Mahesh Vakamudi, Aruna Parameswari

Keywords: Costoclavicular block,Ultrasound-guided nerve block,Single-injection costoclavicular block,Double injection costoclavicular block, block onset time, block performance time,Below-elbow surgery

Abstract: INTRODUCTION The costoclavicular approach targets the brachial plexus in the proximal infraclavicular fossa, where the lateral, medial, and posterior cords are tightly bundled together. Our study compared single- and double-injection ultrasound-guided costoclavicular blocks. We selected onset time as the primary outcome and hypothesized that the double-injection technique would result in faster onset compared with its single-injection counterpart. METHODS 40 patients undergoing below elbow surgery under ultrasound-guided costoclavicular block were randomly allocated to Group A (Single-injection n=20) or Group B (Double injection n=20). In this study, 30 ml of local anesthetic agent (15 mL of 2% lignocaine + adrenaline and 15 ml 0.5 % bupivacaine and 2mg of preservative-free dexamethasone) was used in both groups. In the single-injection group, the entire volume of the local anesthetic was injected between the three cords of the brachial plexus. In the double-injection group, the first half of the volume was administered in the above location, and the second half was deposited between the medial cord and the subclavian artery. After the procedure block onset time, block success rate and block-related pain scores were recorded. In this study additionally block performance time and the number of needle passes were also recorded. RESULTS Block performance time in Group B (5.54±0.38) was significantly lower when compared to the patients in Group A (5.9±0.19) (P- P-value <0.01). Similarly, there was a significantly shorter onset time in Group ‘B’ (17.73±2.79) when compared to the patients in Group ‘A’ (25.5±1.98) with p- p-value < 0.01. The total anesthesia-related time was lower in Group B’ (26.69±2.92) than Group A’ (31.71±3.89) (P-value <0.01). CONCLUSION Compared with its single-injection counterpart, double-injection costoclavicular block results in shorter onset and total anesthesia-related times and provides good analgesia and safe anesthesia for upper limb below-elbow surgeries.