A prospective comparative study of ultrasound guided paravascular supraclavicular brachial plexus block and costoclavicular approach to infraclavicular brachial plexus block in patients undergoing upper limb surgeries

A well conducted regional anesthetic technique has very much to offer to anesthesiologist, surgeon, as well as patients owing to its advantages over general anesthesia such as remaining conscious, avoiding polypharmacy, better hemodynamic stability and excellent post operative analgesia. The introduction of ultrasonography has revived the interest in peripheral nerve blocks. The inherent benefits of direct visualization of nerves and surrounding anatomy, continual observation of needle tip and spread of local anesthetic make ultrasound guided regional anesthesia highly appealing.

 Infraclavicular brachial plexus block and supraclavicular brachial plexus block provides anaesthesia for arm, forearm and elbow.   Although both supraclavicular and infraclavicular blocks can be utilized for upper limb surgeries, anesthesiologists often have a tendency for supraclavicular over infraclavicular block because of the technical difficulty and increased complications with the blind approach in the latter. The advent of ultrasonography in anesthesia practice has made it a valuable adjunct in peripheral nerve blocks.

 Many studies have compared supraclavicular and infraclavicular brachial plexus block but study comparing the ultrasound guided paravascular approach of supraclavicular and costo clavicular approach to infraclavicular brachial plexus block are relatively few. Most of the studies have utilized the corner pocket approach for supraclavicular and lateral parasagittal approach for infraclavicular brachial plexus block. In paravascular approach to brachial plexus block local anesthestic is injected at a single site and hence doesnot require needle repositing.

Similarly costo clavicular approach to infraclavicular brachial plexus block requires single site injection of local anaesthetic until complete blockade is achieved.

The aim is to study para-vascular supraclavicular approach and costo-clavicular approach to infraclavicular brachial plexus block using ultrasound.