Comparison of ultrasound-guided costoclavicular and supraclavicular brachial plexus block for upper extremity surgery: a propensity score matched retrospective cohort study.Ann Palliat Med. 2021 Jan; 10(1):454-461.AP
Ultrasound-guided costoclavicular (CC) brachial plexus blocks (BPBs) are a novel approach for nerve block in upper extremity surgery. However, comparisons between CC-BPB and conventional supraclavicular (SC) BPB have not clearly delineated the benefits or costs of either method.
This retrospective cohort study enrolled patients receiving BPB due to upper extremity fracture between June 2019 and May 2020. Data were collected from the medical records of patients, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, side of block, and operative location. Enrolled patients were matched in a 1:2 ratio using propensity score matching models. The primary outcomes in this study were the proportions of complete sensory and motor blocks and the secondary outcomes included other block-related outcomes, pain-related outcomes, and side effects or complications.
The study enrolled 235 patients with upper extremity fracture and there was a significant difference in the side of block when comparing ultrasound-guided CC-BPB and SC-BPB. After propensity score matching, 62 patients receiving ultrasound-guided CC-BPB and 124 receiving ultrasound-guided SC-BPB were enrolled. The proportions of complete sensory and motor block at each interval after injection showed no significant difference when the groups were compared. Although CC-BPB involved a longer procedure time than SC-BPB (6.2±0.7 vs. 5.1±0.5 min, P<0.001), it provided a longer duration of nerve block (duration of sensory block: 468.2±103.5 vs. 396.5±83.4 min, P<0.001; duration of motor block: 554.6±99.5 vs. 469.7±96.0 min, P<0.001). Patients with Horner's syndrome were also more prevalent in the SC-BCB group (n=11) (8.9%) in comparison to one patient (1.6%) in CC-BPB group (P=0.04).
CC-BPB is a safe and efficient approach for upper extremity surgery.