Comparison of Ultrasound-guided Costoclavicular Block versus Axillary Block for Below Elbow Surgery: A Randomised Clinical Study

Introduction: Ultrasound-guided brachial plexus blocks are widely used to provide anaesthesia for upper limb surgery. Costoclavicular Block (CCB) is a newer infraclavicular approach to brachial plexus block where local anaesthetic is deposited between the midpoint of the clavicle and the first rib. Aim: To compare the efficacy of ultrasound-guided CCB to Axillary Block (AXB) for below elbow surgery. Materials and Methods: This randomised clinical study included 70 patients belonging to ASA I and II category, aged between 18 and 59 years undergoing below elbow surgery. Patients were randomly allocated to either CCB group or AXB group under ultrasound guidance using 20 mL of local anaesthetic mixture (10 mL of 0.5% bupivacaine and 10 mL of 2% lidocaine with adrenaline). Sensorimotor block onset time, block performance time, total anaesthesia-related time, success rate and complications were recorded. Independent t-test was used to determine significance between two quantitative variables and Fischer’s-exact test was used as test of significance for qualitative data. Results: Both groups were comparable in terms of demographic data (age, sex, body mass index and American Society of Anaesthesiologists (ASA) grading) with a p-value of >0.05. The mean (SD) sensorimotor onset time was similar between the CCB and AXB groups (14.71±1.18 vs 14.85±2.33 minutes), respectively; p-value=0.764. Mean block performance time was shorter in CCB than AXB group (5.83±0.82 vs 8.74±0.85 minutes) respectively; p-value <0.001. CCB group had a shorter total anaesthesia-related time compared to AXB group (20.69±0.87 vs 23.79±2.19 minutes) respectively. Success rate was similar between costoclavicular and axillary approaches. No complications were noted in either group. Conclusion: Though the onset time and success rate were similar between the two groups, CCB resulted in a shorter performance time and total anaesthesia-related time. Thus, CCB is a safe and reliable alternative to AXB for below elbow surgery.