ABSTRACT
INTRODUCTION:
A costoclavicular
brachial plexus block is an emerging infraclavicular approach that targets the cords lateral to the
axillary artery, providing rapid onset of sensory-motor blockade. However, the
incidence of hemi-
diaphragmatic paralysis (HDP), a potential complication, remains unclear compared to the widely used supraclavicular (SC) approach. This study aimed to compare the
incidence of HDP between ultrasound-guided costoclavicular and SC
brachial plexus blocks.
OBJECTIVES:
To compare the influence of ultrasound-guided SC and costoclavicular
brachial plexus blocks on diaphragmatic excursion, thickness, and contractility along with pulmonary function. MATERIALS AND
METHODS:
This prospective, randomized, observer-blinded controlled trial included 60
patients undergoing below-
shoulder surgeries.
Patients were randomized to receive either ultrasound-guided SC (Group S) or costoclavicular (Group C)
brachial plexus block with 0.5%
levobupivacaine. The diaphragmatic function was assessed using ultrasonographic evaluation of
diaphragm thickness and diaphragmatic thickness fraction (DTF) pre- and postblock.
Pulmonary function tests (PFTs) (
forced vital capacity (FVC),
forced expiratory volume in one second (FEV1), and
peak expiratory flow rate (
PEFR)) were performed preblock and two hours postblock. Block characteristics were compared.
RESULTS:
The SC group exhibited a significantly larger reduction in DTF from preblock to postblock compared to the costoclavicular group (mean ΔDTF 34.38% vs. 14.01%, p<0.01). Both groups showed significant declines in FVC, FEV1, and
PEFR postblock, but the
magnitude of deterioration was significantly greater in the SC group, displaying no significant difference in block characteristics.
CONCLUSION:
The costoclavicular
brachial plexus block demonstrated superior preservation of diaphragmatic contractility and lesser deterioration of PFTs compared to the SC approach while being equally effective. These findings highlight the potential benefits of the costoclavicular
technique in minimizing diaphragmatic dysfunction and respiratory impairment, particularly in
patients at
risk for respiratory
complications.
