Proximal costoclavicular block for upper extremity trauma and injury surgery in patients with uncompensated blood loss: a case series
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: The proximal costoclavicular approach to the brachial plexus is considered an anatomically advantageous alternative to the classical infraclavicular approach due to the compact arrangement of all three cords within a single fascial sheath. This potentially provides a faster and more predictable onset of the block and reduces the risk of complications. However, data from comparative studies on the speed of sensory and motor block onset remain contradictory, and clinical experience with this technique in routine practice requires further accumulation. Case description: This article presents a case series of 32 patients (median age 38 years) who underwent upper limb surgery (elbow region—8 cases, forearm—16 cases, hand—8 cases). All patients received a brachial plexus block using the proximal costoclavicular approach under ultrasound guidance (LOGIQ system, 12L-RS probe). A mixture of local anesthetics was used: 10 mL of 0.75% ropivacaine and 6 mL of 2% lidocaine (total volume 16 mL). The efficacy of the block was assessed every 5 minutes for 30 minutes post-injection using a 3-point scale. Successful sensory block was achieved in 31 patients (96.9%). The median time to achieve complete sensory anesthesia was 10 minutes [Q1; Q3: 8; 13], and complete motor palsy was 15 minutes [12; 18]. In 5 patients (15.6%), visualization of the cords was suboptimal; however, the block was successful in 4 of them (80%). No complications such as Horner’s syndrome, dysphonia, pneumothorax, or diaphragm paresis were recorded. Conclusion: This case series demonstrates that ultrasound-guided costoclavicular block is a highly effective (96.9%) and safe method of regional anesthesia. The technique provides a predictable block onset time (10–15 minutes) and can be successfully performed even under conditions of suboptimal anatomical visualization. These findings are consistent with the results of recent systematic reviews and confirm the clinical value of the costoclavicular approach in anesthesiology practice.
DOI: 10.17816/ra704191
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225637460