Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis

Abstract

Background: The costoclavicular brachial plexus block (CCB) is a recently established technique that uses the infraclavicular approach and is performed just below the clavicle. This meta-analysis aimed to determine whether CCB can reduce the incidence of hemidiaphragmatic paralysis (HDP), which is a major adverse event related to brachial plexus block (BPB), while yielding comparable block performance as other BPB techniques.Methods: We searched electronic databases to identify relevant studies that compared the incidence of HDP between CCB and other BPB techniques. The primary outcome was the incidence of HDP following CCB and other BPB techniques. The secondary outcomes were pulmonary function test results, other adverse events, and block performance parameters such as onset and performance time. Results: We included six randomized controlled trials that included 414 patients. Compared with the other BPB group, the CCB group had a significantly lower incidence of HDP (relative ratio: 0.21, 95% CI [0.12, 0.36], P < 0.001) and higher peak expiratory flow rate (mean difference: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015). There were no significant between-group differences with respect to other adverse events and block performance parameters.Conclusions: Compared with other BPB techniques, CCB involves a lower incidence of HDP with comparable onset and performance time.

How do you teach someone to fish?

“…This randomized, controlled prospective study with a relatively large sample size reported that the motor blockade efficacy of the CCB and ISB were comparable, while complications such as hemidiaphragmatic paralysis were notably less frequent in the CCB group. This observation aligns with the results of a meta-analysis comparing the CCB with other brachial plexus blocks [ 3 ]. A recent report on a block that serves as an alternative to another plan block for analgesia during upper limb and shoulder surgeries is also available [ 4 ].…”

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

“…While it is true that CCB is a diaphragm-sparing technique when compared to other approaches performed above the clavicle [27], caution should be exercised when comparing studies due to the differences in the definition of HDP used in each study. Our findings appear to conflict with a prior study that reported no cases of HDP when utilizing CCB in shoulder surgery [4].…”