Comparison of efficacy of ultrasound guided continuous Interscalence block vs continuous Costoclavicular Brachial Plexus Block for Humerus Fractures in obese patient. A single center randomized control trial.

Multiple modes of anesthesia and analgesia, such as general anesthesia (GA), interscalene blocks (ISBs), various brachial plexus block approaches, and selective nerve blocks in combination with GA, have been effective for upper limb fracture surgery. Identifying the optimal regional anesthesia for these  surgery is essential for improving postoperative recovery. Interscalene blocks are a standardized and reliable technique for anesthesia and postoperative analgesia during humerus  fracture surgery and are many a times used as the sole means of anesthesia. [1]However, continuous ISBs are associated with a relatively high risk of hemidiaphragmatic paralysis (HDP) and are technically difficult in obese patients with short neck. Several other brachial plexus blocks approaches  distal to the interscalene approach have been proposed such as the costoclavicular block (CCB) .[2,3]This study focuses to evaluate the efficiency of this costoclavicular approach of brachial plexus block in obese patients where giving continuous interscalene block can be challenging.