Background and aims Hemidiaphragmatic paralysis (HDP) due to inadvertent phrenic nerve palsy is a well-recognized complication of supraclavicular block (SCB). the HDP incidence during the newly defined costoclavicular block (CCB, infraclavicular block at the costoclavicular space) has not yet been evaluated. Thus, we performed a retrospective case control study in order to compare the incidence of HDP in CCB with SCB.

Methods 315 patients, who underwent orthopedic surgery under brachial plexus block between January 2018 and December 2018, were divided into two groups, the CCB group (n=118) and the SCB group (n=197). 118 patients were selected in the SCB group by 1:1 propensity score matching. the level of the diaphragm on the block ipsilateral side was measured based on the opposite diaphragm using pre-, post-operative chest X ray images. the primary outcome, HDP was defined as a postoperative elevation of the diaphragm greater than 20 mm. Postoperative SpO2 on room air and any respiratory symptoms were also evaluated.

Results 3 (2.5%) patients in the CCB group versus 46 (39.0%) in the SCB group had HDP (P<0.001; odd ratio, 0.041 [95% confidence interval, 0.012–0.136]). There was no significant difference in postoperative SpO2 on room air. Chest discomfort or tightness was reported 4 patients in SCB group (3.4%). Not only approach method of BPB but also injected volume were significantly associated with HDP.

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Abstract ESRA19-0335 Figure 1

Conclusions The costoclavicular block significantly reduces HDP. Our results suggest that CCB may be considered for brachial plexus blocks in selected patients with pulmonary comorbidities.