Comparison of lateral and medial approaches to costoclavicular brachial plexus block in pediatric patients

Objective: We aimed to compare the effects lateral and medial approaches in USG-guided costoclavicular brachial plexus blocks for postoperative pain managment in children scheduled for lower mid-humerus upper extremity surgeries in aspects of block performing time, number of needle maneuvers, block difficulty, complication development, postoperative analgesia, patient and surgeon satisfaction. Materiel-Method: After obtaining ethics committee approval and family/patient consent; aged between 2-10 years, a total number of 55 children were included in this prospective, randomized, double-blind study. The patients were divided into 2 groups, depending on the lateral or medial approaches. Before the incision, costoclavicular block was applied to the patients using 0.25% bupivacaine at a dose of 1 mg/kg with lateral or medial orientation. During the block performance; the duration of obtaining the ideal USG image, the block performing time, the difficulty of imaging the needle tip and body, the need for additional maneuvers to guide the needle, the need for additional maneuvers for LA distribution, anesthesia and total surgery times were recorded. Motor and sensory block grades for median, ulnar and radial nerves, FLACC scores, additional analgesic need at 0,30th.,60th. minutes, 2nd,4th,6th,12th,18th,24th hours postoperatively, complications, patient and surgeon satisfaction were recorded. Results: The study was completed with 50 patients. There was no siginificant differences between the groups in terms of block success. Imaging time [14 sec(10.5-23), (45 sec(15-73.5)], block performance time [67sec (47-97) vs 150 sec(85-214)], number of target needle maneuvers [1(1-2),3(2-4)] and difficulty level [4(4-5),3(2-5)] were significantly lower in lateral group compared to medial group (p<0.01, p<0.01, p<0.001, p<0.05). Postoperative motor block level was found to be significantly lower in the medial group at 0.,30.,60. min, 2 and 4 hours (p<0.01, p<0.01, p<0.001, p<0.01, p<0.05). There was no significant difference in postoperative FLACC scores and sensory block follow-up (p>0.05). Conclusion: Although the lateral approach in costoclavicular brachial plexus block does not provide a significant advantage in terms of postoperative pain, complication, patient and surgeon satisfaction in costoclavicular brachial plexus block in pediatric patients compared to medial approach. We believe that it is a good option in upper extremity surgeries in terms of short imaging and application time, less number of needle maneuvers and ease of application.