Efficacy of a single injection compared with triple injections using a costoclavicular approach for infraclavicular brachial plexus block during forearm and hand surgery: An observational study

Abstract

Background: The costoclavicular space (CCS), which is located deep and posterior to the midpoint of the clavicle, may be a better site for infraclavicular brachial plexus block than the traditional lateral paracoracoid site. The aim of this stdy was that triple injections in each of the 3 cords in the CC space would result in a greater spread in the 4 major terminal nerves of the brachial plexus than a single injection in the CC space without increasing the local anesthetic (LA) volume. Materials and Methods: Seventy patients who underwent upper extremity surgery randomly received either a single injection (S group, n = 35) or a triple injection (T group, n = 35) using the CC approach. Ten milliliters of 1% xylocaine, 10 mL of 0.5% ropivacaine, and 5 mL of normal saline were used for BPB in each group (total 25 mL). Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5 minutes intervals for 30 minutes immediately after LA administration. Results: Thirty minutes after the block, the blockage rate of all 4 nerves was significantly higher in the T group than in the S group (52.9% in the S group vs 85.3% in the T group, P = .004). But there was no significant difference in the anesthesia grade between the 2 groups (P = .262). The performance time was similar in the 2 groups (3.0 ± 0.9 minutes in the SI group vs 3.2 ± 1.2 minutes in the T group, respectively; P = .54). Conclusion: The triple injection increases consistency in terms of blocking all 4 nerves without increasing the procedure time despite administering the same volume of the LA.