Authors: Senapati L et al.
Cureus. 17(10): e94648, October 15, 2025. DOI: 10.7759/cureus.94648
Summary:
This randomized controlled trial compared ultrasound-guided costoclavicular brachial plexus block (CC-BPB) with supraclavicular brachial plexus block (SC-BPB) for anesthesia and analgesia in elective forearm and hand surgery. The costoclavicular approach, a modification of the infraclavicular technique, targets a compact cluster of cords in the costoclavicular space and may offer technical and safety advantages.
Sixty-four adults (ASA I–III) were randomized to either CC-BPB or SC-BPB (32 per group). All patients received 20 mL of 0.5% ropivacaine under ultrasound guidance. The primary outcome was motor block onset time; secondary outcomes included sensory onset, block performance time, duration of sensory and motor blockade, duration of analgesia, postoperative pain scores, and complications.
Compared with SC-BPB, the CC-BPB group had a significantly shorter block performance time (about 1.5 vs 2.0 minutes), faster onset of sensory block (9 vs 10 minutes), and faster onset of motor block (12 vs 13 minutes). These time differences were statistically significant but modest in absolute terms. There were no differences between the groups in duration of sensory or motor block, duration of analgesia, time to first rescue analgesic, or postoperative pain scores. Complication rates were low and similar in both groups, with no signal of increased adverse events from the costoclavicular approach.
The authors conclude that ultrasound-guided costoclavicular block provides slightly faster onset and quicker performance than the supraclavicular block while maintaining comparable duration of analgesia and safety. CC-BPB is therefore a reliable alternative to SC-BPB for forearm and hand surgery, with choice of approach left to operator experience and patient-specific factors.
What You Should Know
• Both costoclavicular and supraclavicular brachial plexus blocks provided effective anesthesia and analgesia for forearm and hand surgery.
• Costoclavicular block was faster to perform and had slightly quicker sensory and motor onset compared with supraclavicular block.
• Duration of block, duration of analgesia, and time to first rescue analgesic were similar between techniques.
• Postoperative pain scores and complication rates did not differ, supporting comparable safety.
• The costoclavicular approach offers a compact, ultrasound-friendly target and is a practical alternative to the supraclavicular block.
Key Points
• CC-BPB achieved faster block onset and shorter performance time than SC-BPB with the same volume and concentration of ropivacaine.
• No clinically meaningful differences were seen in block duration, analgesic duration, or pain scores.
• Safety profiles were comparable, with no excess complications in either group.
• For upper extremity surgery, CC-BPB can be adopted as an alternative to SC-BPB, with technique selection guided by anatomy, operator comfort, and institutional practice.
• The findings support broader use of the costoclavicular approach as part of the regional anesthesia toolkit for hand and forearm surgery.
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