Costoclavicular vs Paracoracoid Approach to Infraclavicular Brachial Plexus Block: a Feasibility Study

Infraclavicular brachial plexus block under ultrasound guidance is used for surgeries on the upper limb. Traditionally, the block is performed at the lateral infraclavicular fossa where the cords are variable in position relative to the axillary artery. A recently introduced technique is the costoclavicular approach where the cords are viewed as relatively more superficial and clustered together compared to the traditional technique. Those meeting the inclusion criteria and will consent to participate in the study will be randomized to have either an infraclavicular block in the paracoracoid approach (Group 1) or an infraclavicular block in the costoclavicular approach (Group 2). All groups will have the same injectable volume (35 mls) and local anesthetic concentration (ropivacaine 0.5%). There will be 35 study patients for each group for a total of 70 patients.

Inclusion criteria

• Ambulatory elective surgery of the upper limb
• ASA (American Society of Anesthesiologists physical status classification system) 1-4
• Suitable for procedure to be carried out under infraclavicular block

Exclusion criteria

• Inability to give informed consent, Allergy to local anesthetics, morphine or fentanyl
• Ongoing major medical or psychiatric problems
• Narcotic abuse
• Peripheral neuropathy or major neurological problems
• Scarring in area of blockade
• Inability to co-operate with post-operative evaluation
• Major coagulopathy
• Pregnancy and breast-feeding
• Women of childbearing age who are not taking adequate contraceptive precautions