Comparative Study of Subcoracoid Tunnel Block Versus Costoclavicular Block

Regional Anesthesia for Elderly Patients Undergoing Distal Upper Limb Surgeries: A Randomized Comparative Study of Subcoracoid Tunnel Block Versus Costoclavicular Block

The purpose of this study is to compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption, and pain scores) following the ultrasound-guided subcoracoid tunnel block or costoclavicular block for elderly patients undergoing distal upper limb surgeries.

Study Overview

• Status: Not yet recruiting
• Conditions: Distal Upper Limb Surgeries
• Intervention / Treatment: Other: subcoracoid tunnel block; Other: Costoclavicular block

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marwa M Medhat, MD; Phone Number: 01002828937; Email: medhatmarwa9@gmail.com
• Study Contact Backup: Name: Howida A Kamal, MD; Phone Number: 01225096755; Email: K.Howida@yahoO.com

Study Locations

• Egypt
  • Zagazig, Egypt
    • faculty of medicine,zagazig university Egypt
    • Contact: Marwa M Medhat, MD; Phone Number: 01002828937; Email: medhatmarwa@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients acceptance to share in the study.
• Patients with ASA physical status I-II.
• Patients with a body mass index (BMI): of 18.5-30 kg/m2.
• Patients undergoing distal upper limb surgeries not more than 2 hours.

Exclusion Criteria:

• Patients with a history of allergic reactions or contraindications to local anesthetics.
• Patients with significant comorbidities (e.g., severe cardiovascular, neurological, or musculoskeletal disorders).
• Patients with respiratory insufficiency.
• Patients with coagulation disorders or taking drugs affecting surgical hemostasis.
• Patients with pre-existing neurological deficits

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group (S); The patient will receive subcoracoid tunnel block	Other: subcoracoid tunnel block; The probe will be placed with its proximal end towards the mid-clavicular point and distal end with a marker towards the apex of the axilla. A medial tilt of the probe will demonstrate the posterior and medial cords, while a slight lateral tilt of the probe will demonstrate the lateral cord. The needle entry point at the distal end of the probe will be marked. By using the in-plane technique, the needle will be advanced from a caudal to cephalad direction. The probe will be tilted medially, and the needle will be advanced to position its tip above the posterior or medial cord. The probe will be tilted laterally. The needle tip will be repositioned above the lateral cord, and the LA will be injected
Active Comparator: Group (C); The patient will receive costoclavicular block	Other: Costoclavicular block; . The key anatomical structures will be identified under ultrasound: the pectoralis major muscle, subclavius muscle, and three brachial plexus cords (lateral, medial, and posterior) clustered tightly lateral to the axillary artery, along with the axillary artery and vein. The needle will be inserted by the in-plane technique from lateral to medial. The needle tip will be advanced through subcutaneous tissue and subclavius, aiming to land in the costoclavicular fascial plane between the cords, ideally between the lateral and posterior cords and superficial to the medial cord, without traversing neural structure by multipoint strategy, and local anesthesia will be injected.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the onset time of sensory block	the time interval between the end of total local anesthetic administration and complete sensory block	5 minutes after the block

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
block performance time		time of performance of the block
3. Time of first rescue analgesia(naluphine)		24 hours postoperative
Pain intensity	10-point NRS [(0 = no pain, 10 = worst imaginable pain), 1-3: Mild pain (nagging, annoying, slightly interfering with activities of daily living (ADLs), 4 - 6: Moderate pain (significantly interfering with ADLs, 7 - 10: Severe pain (disabling, unable to perform ADLs)]	basal, one, 2, 4, 8, 12, 18, 24, and 24 hours postoperative
patient's satisfaction	The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)	24 hours postoperative
Incidence of block complications	hematoma formation or paresthesia or local anesthetic systemic toxicity.	first 24 hours postoperative

Collaborators and Investigators

• Sponsor: Zagazig University
• Investigators: Study Director: Howida A Kamal, MD, faculty of medicine,zagazig university Egypt

Publications and helpful links

General Publications

• Kaya S, Sahap M, Demirtas K. Comparison of costoclavicular and lateral sagittal infraclavicular approaches in ultrasound-guided brachial plexus block. Agri. 2025 Jan;37(1):32-41. doi: 10.14744/agri.2024.34022.

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2026
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): April 1, 2026

Study Registration Dates

• First Submitted: December 12, 2025
• First Submitted That Met QC Criteria: December 12, 2025
• First Posted (Estimated): December 26, 2025

Study Record Updates

• Last Update Posted (Actual): December 30, 2025
• Last Update Submitted That Met QC Criteria: December 28, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: distal Upper Limb Surgeries Subcoracoid Tunnel Block Costoclavicular Block
• Other Study ID Numbers: ZU-IRB#1885/7-Nov-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No