Lateral Sagittal vs Costoclavicular Approach for Ultrasound-Guided Infraclavicular Block

Lateral Sagittal Versus Costoclavicular Approach for Ultrasound-Guided Infraclavicular Brachial Plexus Block: Comparison of Block Dynamics and Patient Comfort

An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and hand surgery.

The CC approach is a recently introduced infraclavicular approach that targets three cords (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular space. Cords in this space are located more superficially than with the classical approach at the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical relationship with each other.

Patients will be divided into two groups:

Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)

Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)

Inclusion Criteria:

• Age 18 years to 65 years
• Patients scheduled for elective forearm and hand surgeries
• Patients with American Society of Anesthesiologists (ASA) 1-3

Exclusion Criteria:

• Patients not consenting/unwilling to participate
• Age <18 years or >65 years
• Patients with ASA 4
• Obesity (BMI >30 kg/m2)
• Regional anesthesia contraindicated (thrombocytopenia, infection at injection site)
• Severe renal, cardiac, or hepatic disease
• History of hypersensitivity or allergy to local anesthetics
• History of opioid or steroid use for more than 4 weeks
• History of psychiatric disorders
• Analgesic treatment in the last 48 hours preoperatively
• Operations lasting less than 60 minutes and more than 180 minutes
• Patients who converted to general anesthesia