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Comparison of ultrasound-guided supraclavicular and costoclavicular brachial plexus blocks in pediatric patients: a randomized clinical trial

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A Correction to this article was published on 17 December 2022

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Abstract

Purpose

Costoclavicular brachial plexus block has been described recently as a new technique in adults and pediatric patients. In this study, we aimed to compare the supraclavicular and costoclavicular approaches, which are claimed to be effective and practical in pediatric patients.

Methods

Sixty children were randomized to receive supraclavicular (SC group) or costoclavicular (CC group) brachial plexus blocks prior to surgical incision. Block performance times were recorded as the primary outcome. Procedural features (ideal brachial plexus cord visualization/needle pathway planning time, needle tip/shaft visualization difficulty, number of needle maneuvers, requirement of extra needle maneuvers due to insufficient local anesthetic distribution) and postoperative pain-related data (sensorimotor block intensities, Wong-Baker and FLACC pain scores and analgesic requirements) were also evaluated. To observe the tendency toward respiratory complications, ultrasonographic diaphragm movement amplitude (with M-mode) and diaphragm thickness (with B-mode) were measured postoperatively.

Results

A total of 56 patients were included. Block performance times [70(7–97) vs. 115(75–180) s] were significantly lower in the CC group (p < 0.01). The block success rates did not differ (p > 0.05). The incidence of hemidiaphragm paralysis was 44% in the SC group (p < 0.001), and inspiratory diaphragm thickness was significantly lower (p < 0.01). None of CC group patients experienced hemidiaphragm paralysis. All other parameters were comparable (p > 0.05).

Conclusions

Although costoclavicular block did not show superiority in pain management, the block performance was perceived as more practical than supraclavicular block. We believe that costoclavicular brachial plexus block stands as a good option in upper extremity surgeries with the advantages of shorter block performance time and reduced ipsilateral hemidiaphragm paralysis risk in pediatric patients.

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Data availability

The data set used and/or analysed during the current study available from the corresponding author on reasonable request.

Change history

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Acknowledgements

We would like to thank Dr. Zerrin Sungur for randomization setup and preparation and Dr. Omer Berkoz for the surgical care of the patients.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul University Istanbul, Çapa Clinics, Millet Street, 34093, Istanbul, Turkey

    Mehmet Guzel, Emre Sertac Bingul & Meltem Savran Karadeniz

  2. Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA

    Emine Aysu Salviz

  3. Department of Anesthesiology, Beylikduzu State Hospital, Istanbul, Turkey

    Emre Senturk

  4. Department of Anesthesiology, Akcakale State Hospital, Sanliurfa, Turkey

    Mehmet Faruk Cosgun

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  1. Mehmet Guzel
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  2. Emre Sertac Bingul
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Correspondence to Meltem Savran Karadeniz.

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Guzel, M., Bingul, E.S., Salviz, E.A. et al. Comparison of ultrasound-guided supraclavicular and costoclavicular brachial plexus blocks in pediatric patients: a randomized clinical trial. J Anesth 37, 186–194 (2023). https://doi.org/10.1007/s00540-022-03143-7

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  • DOI: https://doi.org/10.1007/s00540-022-03143-7

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