Comparison Between Ultrasound-Guided Costoclavicular and Lateral-Sagittal Infraclavicular Brachial Plexus Blocks in Adult Distal Upper Limb Surgeries : A Randomized Controlled Trial

The aim of the study is to compare the onset time of the costoclavicular approach of brachial plexus block with that of the lateral-sagittal infraclavicular approach in adults distal upper limb surgeries.

Study Overview

• Status: Recruiting
• Conditions: Brachial Plexus Blocks; Regional Anesthesia Block
• Intervention / Treatment: Procedure: Lateral-sagittal infraclavicular brachial plexus block; Procedure: Costoclavicular brachial plexus block

Detailed Description

Regional anesthesia is commonly used for distal upper limb surgeries as it provides effective surgical anesthesia, reduces opioid consumption, and offers prolonged postoperative analgesia. Ultrasound-guided infraclavicular brachial plexus block is a well-established technique for these procedures. The traditional lateral-sagittal infraclavicular approach (LS-ICB) provides reliable anesthesia but may require multiple needle redirections to achieve adequate spread of local anesthetic around the cords of the brachial plexus. The costoclavicular (CC) approach is a newer ultrasound-guided infraclavicular technique in which the three cords of the brachial plexus are clustered together in the costoclavicular space, potentially allowing easier needle placement and faster spread of local anesthetic.

This prospective randomized controlled trial will include 50 adult patients undergoing distal upper limb surgery under regional anesthesia. Participants will be randomly assigned into two equal groups (25 patients each). Group CC will receive an ultrasound-guided costoclavicular brachial plexus block, while Group ICB will receive an ultrasound-guided lateral-sagittal infraclavicular brachial plexus block.

In both groups, the block will be performed using a mixture of 2% lidocaine and 0.5% bupivacaine in a 1:1 ratio with a total volume of 0.3 mL/kg, administered under real-time ultrasound guidance.

The primary outcome of the study is the time to onset of complete sensory and motor blockade after injection of the local anesthetic solution. Sensory block will be assessed using pinprick testing in the distributions of the median, ulnar, radial, and musculocutaneous nerves.

Secondary outcomes include block performance time, block success rate, incidence of complications (such as vascular puncture, pneumothorax, or local anesthetic systemic toxicity), postoperative pain scores, and total analgesic consumption during the first 24 hours after surgery. The findings of this study may help identify the most effective and safe infraclavicular block technique for distal upper limb surgeries.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahmed Hesham Shahin, M.B.B.CH; Phone Number: +201270857308; Email: 160634@med.asu.edu.eg

Study Locations

• Egypt
  • Cairo, Egypt
    • Recruiting
    • Ain Shams University Hospitals
    • Contact: offices of professor D. Vice President; Phone Number: +20226947820; Email: info@ainshams.edu.eg

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• ASA physical status I-III
• Distal upper limb surgery requiring brachial plexus block.
• Patient approval after written and informed consent to participate.

Exclusion Criteria:

• Patient refusal.
• Allergy to drugs used.
• Infection at puncture site.
• Coagulopathy or anticoagulant therapy.
• Pre-existing neuropathy or neurological deficit in the affected limb.
• Severe pulmonary disease.
• BMI > 40 kg/m².

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Lateral-sagittal infraclavicular block (LS-ICB) group; Drug : A mixture of 2% lidocaine and 0.5% bupivacaine with volume of 0.3 mL/kg and a ratio of 1:1.	Procedure: Lateral-sagittal infraclavicular brachial plexus block; Ultrasound-guided lateral-sagittal infraclavicular brachial plexus block performed using a high-frequency linear probe. A mixture of 2% lidocaine and 0.5% bupivacaine (1:1 ratio) with a total volume of 0.3 mL/kg is injected around the cords of the brachial plexus under real-time ultrasound guidance.
Active Comparator: Costoclavicular block brachial plexus (CC) group	Procedure: Costoclavicular brachial plexus block; Ultrasound-guided costoclavicular brachial plexus block performed using a high-frequency linear probe. A mixture of 2% lidocaine and 0.5% bupivacaine (1:1 ratio) with a total volume of 0.3 mL/kg is injected in the costoclavicular space around the cords of the brachial plexus under real-time ultrasound guidance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to onset of complete sensory and motor block	Time from completion of local anesthetic injection to achievement of complete sensory and motor blockade. Sensory block will be assessed using pinprick testing in the distributions of the median, ulnar, radial, and musculocutaneous nerves. Motor block will be graded using a standardized motor scale. And time will be in minutes and seconds.	From completion of injection up to 30 minutes after block performance

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): February 16, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: April 2, 2026
• First Posted (Actual): April 8, 2026

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: April 2, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: FMASU MS 101/2026

Drug and device information, study documents

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