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Anatomic Basis for Brachial Plexus Block at the Costoclavicular Space: A Cadaver Anatomic Study
  1. Xavier Sala-Blanch, MD*,,
  2. Miguel Angel Reina, MD, PhD,§,
  3. Pawinee Pangthipampai, MD and
  4. Manoj Kumar Karmakar, MD, FRCA, FHKCA, FHKAM
  1. From the *Department of Anesthesiology, Hospital Clinic Barcelona; †Department of Human Anatomy and Embryology, University of Barcelona, Barcelona; ‡Department of Anesthesiology, Madrid-Montepríncipe University Hospital; §School of Medicine, CEU San Pablo University, Madrid, Spain; and ∥Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
  1. Address correspondence to: Manoj Kumar Karmakar, MD, FRCA, FHKCA, FHKAM, Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China (e-mail: karmakar{at}


Background and Objectives The costoclavicular space (CCS), which is located deep and posterior to the midpoint of the clavicle, may be a better site for infraclavicular brachial plexus block than the traditional lateral paracoracoid site. However, currently, there is paucity of data on the anatomy of the brachial plexus at the CCS. We undertook this cadaver anatomic study to define the anatomy of the cords of the brachial plexus at the CCS and thereby establish the anatomic basis for ultrasound-guided infraclavicular brachial plexus block at this proximal site.

Methods The anatomy and topography of the cords of the brachial plexus at the CCS was evaluated in 8 unembalmed (cryopreserved), thawed, fresh adult human cadavers using anatomic dissection, and transverse anatomic and histological sections, of the CCS.

Results The cords of the brachial plexus were located lateral and parallel to the axillary artery at the CCS. The topography of the cords, relative to the axillary artery and to one another, in the transverse (axial) plane was also consistent at the CCS. The lateral cord was the most superficial of the 3 cords and it was always anterior to both the medial and posterior cords. The medial cord was directly posterior to the lateral cord but medial to the posterior cord. The posterior cord was the lateral most of the 3 cords at the CCS and it was immediately lateral to the medial cord but posterolateral to the lateral cord.

Conclusions The cords of the brachial plexus are clustered together lateral to the axillary artery, and share a consistent relation relative to one another and to the axillary artery, at the CCS.

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  • The authors declare no conflict of interest.

    This work was locally funded by the Department of Anesthesiology, University of Barcelona, Barcelona, Spain.