Comparison of supraclavicular and costoclavicular brachial plexus blocks in pediatrics

Objective: USG-guided regional nerve blocks are used as a part of postoperative multimodal pain management in unilateral mid-humerus distal upper extremity surgeries in children. We aimed to compare two of these brachial plexus block methods are with the more common used supraclavicular (SC) and the costoclavicular (CC) method, which is a new approach, primarily block performance time, secondary procedural difficulty parameters, postoperative analgesic effectiveness, complications especially the incidence of hemidiaphragmatic paralysis (HDP) due to possible phrenic nerve blockade, parents/patient and surgeon satisfaction. Materials and methods: 60 children aged 2-10 years, with parental consent after ethics committee approval, were included in this prospective, randomized, double-blind study. After dropouts the patients were divided into 2 groups as SC and CC. The related block was applied to the patients before the incision using 0.25% bupivacaine at a dose of 1 mg/kg. During the block application, ideal USG visualization time, block performance time, the difficulty of imaging the needle tip and shaft, number of needle maneuvers to reach target, requirement of additional maneuvers due to insufficient local anesthetic distrubution, anesthesia and total surgery times were recorded. During the operation, MAP, HR were recorded at the first monitorization, induction, then every half hour and during extubation. Diaphragm movement amplitude with USG M-mode; Diaphragm thickness measurements were made with B-mode and recorded. Motor and sensory block degrees for musculocutaneous, median, ulnar and radial nerves, Wong-Baker and FLACC scale values in the first 24 hours postoperatively, time to first pain, additional analgesic requirement, complications, and patient and surgeon satisfaction were recorded. Results: The study was completed with 56 patients. Although there was no significant difference between the groups in terms of block success, the duration of block [70 (47-97), 115 (75-180)] was significantly lower in the CC group compared to SC group (p<0.01). The incidence of HDP was found 44% in the SC group (p<0.001), and inspiratory diaphragm thickness was significantly lower (p<0.01). Conclusion: In pediatric patients, although the lateral approach in CC block does not provide a significant advantage in terms of postoperative pain control, number of needle maneuvers, procedure difficulty, patient-surgeon satisfaction compared to SC block, we think that it is a good option in upper extremity surgeries with the advantages of short block performance time and especially reduced ipsilateral HDP risk.