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Abstract
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Background and Aims The costoclavicular approach of infraclavicular brachial plexus block targets proximal infraclavicular fossa where medial, lateral and posterior cords lie close to each other. This trial compared the efficacy of single injection with the triple aliquot injection technique for costoclavicular block in terms of onset, success and duration of the block. The research hypothesis was that the triple aliquot injections result in quicker onset time and less failure rate as compared to single injection costoclavicular block. The primary objective of the study was to compare the anaesthesia onset time between two groups.
Methods Forty-two patients undergoing upper limb surgery were randomly allocated to receive either single (n=21) or triple point (n=21) ultrasound-guided costoclavicular brachial plexus block. The local anaesthetic volume of 20 ml of 0.75% ropivacaine plus 10 ml of 2% lignocaine with 1 mcg/kg clonidine solution was same in both groups. After completion of the block, imaging, needling, performance time, and block onset time, success of surgical anaesthesia and pain score was recorded.
Results Compared to the single injection technique, the triple injection group displayed a faster onset time ( 15.71 ± 4.55 vs 25.95±3.4 min; p-value < 0.001). However, imaging time and performance time were more in the triple aliquot injection group ( performance time 12.05 ± 3.51 vs 5.52±1.47 min ; p value< 0.001).
Anatomy of Costoclavicular space and three points of injection
Conclusions The triple injection ultrasound-guided costoclavicular brachial plexus block had shorter onset time than its single injection counterpart. Single point costoclavicular block as compared to triple point costoclavicular block had less imaging, needling and performance time.