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EP194 Comparison between the medial and lateral approaches of ultrasound-guided costoclavicular brachial plexus block for upper limb surgeries- a randomised control trial
  1. Nishant Patel,
  2. Saranlal AM,
  3. Kanil R Kumar,
  4. Rakesh Kumar,
  5. Arshad Ayub,
  6. Puneet Khanna and
  7. Bikash Ranjan Ray
  1. AIIMS, New Delhi, New Delhi, India


Background and Aims The aim of our study is to compare medial and lateral approaches of the costoclavicular BPB which became procedure of choice for upper limb anaesthesia. We hypothesized costoclavicular block through medial approach would result in shorter performance time owing to favourable anatomy.

Methods After IEC approval, 60 patients participated, 30 in each group. 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 preliminarily analysed were Imaging time, Needling time, Total Anaesthesia time, Anaesthesia success, Performer difficulty score. Further subgroup analysis concerning other outcomes are ongoing. As two patients were switched over to Group L due to unfavourable sono-anatomy, we ran statistical analysis by modified Intention to treat analysis and as per protocol analysis. We summarise results from mITT analysis.

Results The mean±SD for performance time (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 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.

Abstract EP194 Table 1

Showing the baseline characteristics between the two study groups

Abstract EP194 Table 2

Shows the performance time in performing the block by two approaches

Abstract EP194 Figure 1

Shows box & whisker plot for performance time and secondary outcomes like imaging time, needling time, block onset time, total anaesthesia time and time to first postoperative analgesia

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.

  • USG GUIDED regional anaesthesia
  • Anesthesia for Upper limb surgery

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