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Evaluating the spread of costoclavicular brachial plexus block: an anatomical study
  1. Veerandra Koyyalamudi1,
  2. Natalie R Langley2,
  3. Monica W Harbell1,
  4. Molly B Kraus1,
  5. Ryan C Craner1 and
  6. David P Seamans1
  1. 1Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA
  2. 2Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  1. Correspondence to Dr Veerandra Koyyalamudi, Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA; v.1313{at}


Background and objectives The costoclavicular brachial plexus block is performed deep and posterior to the midpoint of the clavicle. There are limited data evaluating the spread of the costoclavicular brachial plexus block. We performed a cadaveric study to evaluate the spread of injectate after a costoclavicular brachial plexus block.

Methods Five ultrasound-guided costoclavicular block injections were performed with 20 mL of 0.1% methylene blue. The brachial plexus and its branches were dissected from the level of C4 to the lower axilla. The extent of dye spread was recorded including spread to the phrenic nerve, suprascapular nerve, roots, trunks, divisions, cords and terminal branches of the brachial plexus.

Results The dye extended cephalad to the level of the cricoid cartilage in two of the five injections; three injections had dye extending 0.75 cm, 1.5 cm and 2 cm caudad to the level of the cricoid cartilage, respectively. The C7, C8 and T1 nerve roots were stained in all injections. The dye did not extend cephalad to the C5 and C6 nerve roots. All trunks, cords and divisions of the brachial plexus were stained, as was the suprascapular nerve. There was no spread of dye to the phrenic nerve in any of the specimens.

Conclusions This cadaveric study demonstrates that ultrasound-guided injection in the costoclavicular space spreads cephalad to the brachial plexus in the supraclavicular space, consistently reaching the suprascapular nerve and all trunks and cords of the brachial plexus, while sparing the phrenic nerve.

  • brachial plexus
  • upper extremity
  • acute pain
  • pain management
  • nerve block

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  • Contributors Study design/planning, Data acquisition, analysis, interpretation, writing manuscript, revision and approval of final manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was deemed exempt by the Mayo Clinic Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Additional data include ultrasound images of the costoclavicular block being performed and photographs of dye spread in cadavers. Deidentified data will be made available on reasonable request by contacting the corresponding author. Reuse is not permitted.