A randomised controlled trial comparing single site versus two sites administration of costoclavicular blocks under ultrasound guidance for below-elbow procedures

• Author Details:   
• Shivanika Selvam
• Rajesh Kumar Kodali V ^*
• Ramkumar Dhanasekaran
• Mahesh Vakamudi
• Aruna Parameswari

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Background: The costoclavicular block has been recently adopted for upper limb procedures. The costoclavicular space is situated within the proximal infraclavicular fossa, where the three cords of the brachial plexus are closely aggregated. This study evaluated single-site and two-site injection strategies for ultrasound-guided costoclavicular blocks.

Materials and Methods: Forty patients scheduled for below-elbow surgery with costoclavicular block were randomly allocated to Group A (single site injection, n=20) or Group B (two site injection, n=20). Both groups received 30 millilitres(mL) of a local anaesthetic solution that contained 5 microgrammes per mL of adrenaline in 15 mL of 2% lignocaine, 2 milligrams of preservative-free dexamethasone added to 14.5 millilitres of 0.5% bupivacaine. In Group A, the entire volume of anaesthetic solution was administered between the three cords of the brachial plexus. In Group B, the initial portion of 15 ml volume was given at the above-described spot, while the remaining was delivered between the axillary artery and medial cord. The principal outcome of this study was costoclavicular block onset time. Other outcomes like block performance time, imaging, needling time and total anaesthesia related time were also recorded.

Results: Group ‘B’ exhibited a significantly shorter onset time (18.7±2.7 min) compared to Group ‘A’ (25.5±1.9 min) (P=0.0005). Block performance time was significantly lower in Group ‘B’ (5.5±0.3 min) than in Group ‘A’ (5.9±0.1 min) (P=0.01). Group B patients also had lesser imaging time (50.9 sec) than Group A (62.5 sec) (P = 0.001). Needling time was more in Group B (5.3 min) than in Group A (4.7 min) (P= 0.0005). The total anaesthesia related time was lower in Group ‘B’ (26.6±2.9 min) than Group ‘A’ (31.7±3.8min) (P=0.01).

Conclusion: The two-site costoclavicular block provides shorter onset time, and shorter block performance time and reduced overall anaesthesia duration compared to its single-site injection counterpart, for upper limb procedures.