A Comparison of Anesthetic Quality between Single and Septum-based Double Injection for Ultrasound-Guided Costoclavicular Block: A Randomized Controlled Trial
- Authors
- Lee, Mi Geum; Chung, Seung Hyun; Jung, Wol Seon; Lee, Dong Chul; Yoon, Kyung Seob; Koh, Jae Chul; Shin, Hyeon Ju
- Issue Date
- Nov-2022
- Publisher
- AM SOC INTERVENTIONAL PAIN PHYSICIANS
- Keywords
- Brachial plexus block; costoclavicular approach; infraclavicular block; double injection; ultrasound
- Citation
- PAIN PHYSICIAN, v.25, no.8, pp.E1183 - E1189
- Journal Title
- PAIN PHYSICIAN
- Volume
- 25
- Number
- 8
- Start Page
- E1183
- End Page
- E1189
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/86654
- ISSN
- 1533-3159
- Abstract
- Background: In a costoclavicular (CC) approach of an ultrasound (US)-guided infraclavicular brachial plexus block (BPB), a septum between the lateral and the medial/posterior cords can result in an incomplete block. We hypothesized that double injections in each compartment between the septum would result in a higher success rate of BPB than a single injection in the center of the CC space. Objectives: This study was conducted to confirm the superiority of block quality achieved by septum-based double injections (experimental group; group E) over single injection in the center of the CC space (control group; group C). Study Design: A randomized, controlled trial Setting: Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Anam Hospital. Methods: Sixty-eight patients who underwent upper extremity surgery randomly received a single (SI group, n = 34) or a septum-based double injection (DI group, n = 34) using the CC approach. Ten milliliters of 2% lidocaine, 10 mL of 0.75% ropivacaine, and 5 mL of normal saline were used for BPB in each group (total 25 mL). Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5-minute intervals for 30 minutes immediately after local anesthesia administration. The assessed variables were the success rate, the rate of all 4 nerves blockade, and onset time. Results: Thirty minutes after the block, the success rate was significantly higher in the DI group than in the SI group (64.7% in the SI group vs 91.2% in the DI group, P = 0.009), and the rate of all 4 nerves blockade also significantly increased in the DI group compared to the SI group (44.1% in the SI group vs 91.2% in the DI group, P = 0). The onset time was significantly shortened in the DI group compared with the SI group (26.3 +/- 5.6 min in the SI group vs 21.3 +/- 6.2 min in the DI group, P = 0.010). Conclusions: Compared with the SI, the septum-based DI of CC approach increased the success rate and the rate of all 4 nerves blockade and shortened the onset time.
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