Efficacy of Lateral Sagittal Versus Costoclavicular Approach in Ultrasound-Guided Infraclavicular Block for Below Elbow Surgery: A Randomized Controlled Trial.

Background The infraclavicular brachial plexus block is a widely used regional anesthesia technique for below-elbow surgeries. The lateral sagittal (LS) and costoclavicular (CC) approaches differ anatomically and technically, potentially affecting block performance and outcomes. This study aimed to compare the efficacy of the LS and CC approaches for ultrasound-guided infraclavicular brachial plexus block in terms of block success, procedural time, onset of sensory and motor blockade, and patient and surgeon satisfaction. Methods A randomized controlled trial was conducted between April 2024 to April 2025 at Shree Krishna Hospital, Karamsad, Gujarat, a tertiary care teaching hospital involving 48 adult patients undergoing elective below-elbow surgery, randomized equally to receive 22 mL of local anesthetic solution (20 mL of 0.5% ropivacaine mixed with 2 mL of 8 mg of dexamethasone) either by the LS or CC approach. Block performance time, sensory and motor block onset, satisfaction scores, and complications were assessed. Results The CC approach demonstrated a significantly shorter block performance time [median: 8 minutes (IQR 6-8)] compared to the LS approach [median: 10 minutes (IQR 8-12.3)] (p < 0.001), with a median difference of 2.05 minutes (95% CI: -5.5 to 9.0). The onset of sensory blockade was shorter in the CC group [15 minutes (IQR 15-20)] compared to the LS group [20 minutes (IQR 15-20)], although this difference was not statistically significant (p = 0.145; median difference 0.0 minutes, 95% CI: -5 to 10). A statistically significant difference was observed in the onset of motor blockade (p = 0.012); however, median values were similar between groups, with a median difference of 0.0 minutes (95% CI: -5 to 10), suggesting limited clinical relevance. Patient and surgeon satisfaction were high and comparable between groups (odds ratio: 0.64, 95% CI: 0.10-4.20), and no complications were reported. Conclusion The costoclavicular approach is associated with shorter block performance time, while demonstrating comparable sensory and motor blockade characteristics and satisfaction outcomes when compared to the lateral sagittal approach. These findings suggest that both techniques are effective and clinically acceptable options for infraclavicular brachial plexus block in below-elbow surgeries. Further large-scale, multicenter studies are warranted to confirm these findings and to evaluate additional clinically relevant outcomes, including duration of analgesia and operator learning curves.