A prospective randomized interventional study comparing lateral sagittal and costoclavicular approaches for ultrasound-guided infraclavicular brachial plexus block

• Author Details:   
• Abhijith Rao ^*
• Sushil Bhati
• Sonali Bhatia
• Raman Deep

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Background and Aim: Infraclavicular brachial plexus block is a reliable regional anesthesia technique for upper limb surgeries. Among the commonly used approaches, the costoclavicular (CC) and lateral sagittal (LS) techniques target the brachial plexus at distinct anatomical sites, each with specific advantages and limitations. This randomized controlled trial aimed to compare the CC and LS approaches in terms of onset times for sensory and motor block and overall time to readiness for surgery.

Materials and Methods: A total of 128 patients, aged 18–60 years with ASA physical status I or II, scheduled for upper limb surgery under regional anesthesia, were randomized into two groups: Group A (LS approach) and Group B (CC approach). Each patient received 25 mL of 0.5% ropivacaine. Sensory and motor block of the median, ulnar, radial, and musculocutaneous nerves were assessed using a verbal rating scale (0–5) and a qualitative scale (0–2), respectively, at regular intervals. The primary outcome was time to readiness for surgery; secondary outcomes included onset times for sensory and motor block, block performance time, and time to first rescue analgesia.

Results: The CC approach (Group B) demonstrated significantly faster onset of sensory block (7.5 min [IQR 6.25–8.75]) and motor block (5 min [IQR 5–5]) compared to the LS approach (Group A: sensory = 15 min [IQR 15–16.25]; motor = 10 min [IQR 5–10]) (p<0.001). Time to readiness for surgery was also significantly shorter in the CC group (7.5 min vs 15 min, p<0.001). No significant difference was observed in block performance time (p = 0.593) or time to first rescue analgesia (p = 0.338) between the groups.

Conclusion: The costoclavicular approach to infraclavicular brachial plexus block offers a faster onset of sensory and motor blockade and quicker readiness for surgery compared to the lateral sagittal approach, with comparable safety and performance profiles.