A study to compare ultrasound-guided costoclavicular approach with supraclavicular approach for brachial plexus block in upper limb surgeries

The supraclavicular(SC) and infraclavicular(IC) brachial plexus blocks have a similar distribution of anaesthesia, and both can be used effectively for surgeries of upper limb.1 Costoclavicular approach of brachial plexus block (BPB)is a modification of ultrasound-guided infraclavicular brachial plexus block. Under ultrasound guidance, the costoclavicular space (CCS) is visualized as a well-defined intermuscular space, lying deep and posterior to the mid-point of the clavicle. It is located between the clavicular head of the pectoralis major and subclavius muscle anteriorly and the upper slips of the serratus anterior muscle and the second rib posteriorly. All 3 cords of the brachial plexus are visualized in a single transverse sonogram of the CCS as the cords are clustered together lateral to the axillary artery and exhibit a consistent triangular arrangement. The needle can be easily directed to the centre of the plexus with minimal discomfort to patient. 2 Whereas Ultrasound-guided supraclavicular block targets the brachial plexus trunks which gather at the lower part of the interscalene space, surrounding the subclavian artery. This level carries the advantage of being the area where the trunks are most compact. With a high-frequency probe placed parallel and against the clavicle in the coronal oblique plane, the brachial plexus (trunk or division) appears as a cluster of hypoechoic nodules located lateral, posterior, and superior to the subclavian artery (hypoechoic and pulsatile) and just above the underlying first rib (hyperechoic and curvilinear). Care should be taken to avoid intravascular injection of surrounding vessels (i.e., the suprascapular artery or dorsal scapular artery)by using color Doppler. The needle is slowly advanced under direct visualization with an in-plane approach (from lateral to medial) toward the angle formed by the first rib and the subclavian artery.The goal of the supraclavicular technique is to see the spread of local anesthetic reaching the angle between the first rib and the subclavian artery.3 Very few studies are done to compare the efficacy of costoclavicular approach of brachial plexus block with the conventional supraclavicular block. Hence the present study will be undertaken to know the safety and effectiveness of two approaches of Brachial plexus block in upperlimbsurgeries.