Safety and Efficacy of Ultrasound Guided Costoclavicular Brachial Plexus Block versus Interscalene Block in Adult Patients Undergoing Shoulder Surgery. A Prospective Randomized Double Blinded Study

Abstract

Background: Adults who have shoulder surgery often experience acute postoperative pain; around 45% of individuals experience significant pain in the first few days after surgery. The aim of this work was to compare safety and efficacy of ultrasound guided costoclavicular brachial plexus block versus interscalene block in adult patients undergoing shoulder surgery. Methods: This prospective randomized controlled double blinded study was carried out on 80 patients admitted for shoulder surgery. Patients were divided into two equal groups: Group I: Ultrasound guided Interscalene Block (ISB), in this group brachial plexus was blocked by 15 ml of levobupivacaine 0.5%, and group II: Ultrasound guided costoclavicular brachial plexus block (CCBPB), in this group brachial plexus was blocked by 20 ml of levobupivacaine 0.5%. Results: The onset of sensory block was significantly shorter in ISB group (P<0.001). The incidence of hemidiaphragmatic paralysis was statistically significant higher in ISB group (P<0.001). At various measurement periods, there was no discernible difference in VAS between the two groups (p > 0.05). There was no statistically substantial difference between the two groups for the initial rescue analgesic need (P=0.080). Conclusions: Although, ultrasound guided CCBPB and ISB has the same efficacy on providing postoperative analgesia for shoulder surgery, CCBPB is safer than ISB because it decreases the incidence of postoperative complications as hemidiaphragmatic paralysis (HDP), hoarseness of voice, pneumothorax, Horner's syndrome, and local anaesthetic systemic toxicity.