An observational study of ultrasound guided infraclavicular brachial plexus block with Costoclavicular and Retroclavicular approaches for upperlimb orthopedic surgeries

Most upper limb surgeries are done under brachial plexus block as it provides anesthesia along with postoperative analgesia without any need of airway manipulation.

According to site of injury and other factors Brachial plexus block is given through various approaches like Interscalene block, Supraclavicular, Infraclavicular or Axillary .Infraclavicular block provides excellent anesthesia for upper limb surgeries.

The infraclavicular brachial plexus has easily recognisable sonoanatomy, a high success rate, and low risk of pnemothorax. Identification of the axillary artery is the key landmark in performing this block.The use of ultrasound (USG) adds valuable information such as visualisation of the needle tip and real-time observation of the injectate surrounding the nerves. Use of USG also reduces the risk of adverse events such as inadvertent intravascular injection and trauma to surrounding structures.

In the costoclavicular approach, the ultrasound transducer is placed parallel to and below the clavicle. In this view, the cords are clustered together, at a more superficial level,the cords could be blocked more rapidly with the CC approach and that the block is administered faster and requires a fewer number of needle redirections. There is no increased incidence of pneumothorax with the CC approach.

The Retroclavicular approach consists of inserting the needle in the supraclavicular fossa, behind the clavicle, in-plane in a paramedian sagittal plane cephalo-caudad direction until the needle tip is positioned behind the axillary artery with the US probe resting in the delto-pectoral groove.The point of needle insertion, however, is over the trapezius muscle posteriorly. This approach allows the needle to pass between the scapula and the clavicle toward the axillary artery in the infraclavicular area.

These two techniques are simple, reliable ,safe and effective.In our institute so far no study evaluating the characteristics of these two techniques is done. Hence, we are planning to do this study.