Background and Aims The aim of our study is to compare medial and lateral approaches of the costoclavicular BPB which has become procedure of choice for upper limb anaesthesia. We hypothesized that costoclavicular block through medial approach would result in shorter performance time owing to the absence of bony anatomical structures in medial aspect.
Methods After IEC approval, 62 patients were assessed for eligibility of which 2 patients declined to participate in the study. In group M, needle was advanced in a medial to lateral direction, whereas in Group L, needle was advanced in lateral to medial direction. 20ml of 0.5% bupivacaine were used in both groups. The primary outcome assessed was performance time. The secondary outcomes analysed were Imaging time, Needling time, Block onset time, Total Anaesthesia time, Anaesthesia success, Performer difficulty score. As two patients were switched over to Group L due to unfavourable anatomy, we ran statistical analysis by modified Intention to treat analysis.
Results The mean +/- SD for performance time (in mins) were 11.9+/-3.8 in Group M and 9.4+/-4.1 in Group L with difference of mean (95%CI) of 2.4 (0.3 to 4.5) with p-value <0.05.Similarly, imaging, needling, total anaesthesia time were also higher in Group M. Performer difficulty score (Grade 2&3) [66.67% vs 48.2%,p-value- 0.032] was also higher in Group M compared to Group L.
Conclusions Our findings revealed medial approach have no significant advantage over lateral approach with regards to performance time, imaging time, needling time, total anaesthesia time and performer difficulty but with marginally higher block success rate.
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