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

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

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

Patients for upper limb surgeries who are candidates for infraclavicular block will be screened. Two techniques of infraclavicular block will be compared. Measured outcomes are performance times, block onset times, patient satisfaction, quality of block, and requirement for supplementary analgesia.

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.

Ultrasound-guided infraclavicular block using Ropivacaine 0.5% 35 mL using the costoclavicular approach

Ultrasound-guided infraclavicular block using Ropivacaine 0.5% 35 mL using the paracoracoid or standard approach

From the time needle is removed from the patient's skin up to the time when block is considered adequate for surgery

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

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