Infraclavicular Block Techniques: A Randomized Comparison of Costoclavicular and Paracoracoid Ultrasound-guided Approaches in Upper Limb Surgery

Background: Anesthesia and analgesia for upper limb procedures are commonly achieved through ultrasound-guided infraclavicular block (ICB). The traditional paracoracoid (PC) approach involves injecting local anesthetic (LA) dorsal to the axillary artery. Aim: This study aimed to compare the efficacy of these two approaches in terms of adverse events, block time, success rate, and needle passes. Method: This randomized controlled trial involved 90 patients undergoing emergency or elective upper limb surgery. Patients were randomly assigned by computer-generated random number sequence to either the PC group (Group PC, n = 45) or the costoclavicular (CC) group (Group CC, n = 45). Results: There was no significant difference in block performance time between the two groups (Group PC: 12.93 ± 2.449 min and Group CC: 13.17 ± 2.365 min). The CC approach resulted in a slightly faster onset of sensory (17.53 ± 2.013 min vs. 20.47 ± 3.667 min) and motor block (18.60 ± 3.663 min vs. 29.40 ± 37.359 min). Conclusion: The CC approach may offer a slightly faster onset of sensory and motor block due to the compact anatomy of the brachial plexus in this region despite similar block performance times. While both approaches are reliable, further research may be needed to identify optimal techniques for specific patient populations.