Comparison of costoclavicular with infraclavicular block for upper limb surgeries: A meta-analysis

Clinical Snapshot

Key Findings

• P Value: P = 0.02

• Effect Size: SMD = -0.29 (favouring costoclavicular block)

• Primary Outcome: Block onset time significantly shorter with costoclavicular approach

• Nnt Or Sensitivity: Clinical significance unclear - no time difference in minutes reported

• Confidence Interval: 95% CI = -0.53 to -0.05

Clinical Application

Both techniques require ultrasound guidance and specialist anaesthetic skills Relevant to Australian anaesthetic practice, though technique adoption may vary between centres. No specific PBS or TGA implications for equipment or medications Patients undergoing upper limb surgery requiring brachial plexus block

Abstract

BACKGROUND: The influence of costoclavicular versus infraclavicular nerve block on the analgesia for upper limb surgeries remains elusive. This meta-analysis and systematic review aim to study the analgesic efficacy of costoclavicular versus infraclavicular nerve block for upper limb surgeries. METHODS: We have searched several databases, including PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases from inception to January 2024, and randomized controlled trials (RCTs) assessing the effect of costoclavicular versus infraclavicular nerve block for upper limb surgeries were included. The inclusion criteria were presented as follows: study design was RCT, patients underwent upper limb surgeries, and intervention treatments were costoclavicular nerve block versus infraclavicular nerve block. Studies without English abstracts were excluded. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes, while odds ratio (OR) with 95% CI was applied to evaluate dichotomous outcomes. RESULTS: Six RCTs and 434 patients were included in this meta-analysis. Compared with infraclavicular nerve block for upper limb surgeries, costoclavicular nerve block was able to significantly decrease block onset time (SMD = -0.29; 95% CI = -0.53 to -0.05; P = .02), but demonstrated no influence on performance time (SMD = -0.26; 95% CI = -0.85 to 0.34; P = .40), number of passes (SMD = -0.08; 95% CI = -0.40 to 0.24; P = .61), vascular puncture (OR = 0.25; 95% CI = 0.04 to 1.56; P = .14) or Horner syndrome (OR = 1.02; 95% CI = 0.04 to 27.64; P = .99). CONCLUSION: Costoclavicular nerve block may need shorter block onset time for upper limb surgeries compared to infraclavicular nerve block, but more RCTs were needed to confirm these findings.

References

1. 1.Zhao, J., Ren, W., Hou, X., Han, C., & Wang, Z. (2026). Comparison of costoclavicular with infraclavicular block for upper limb surgeries: A meta-analysis. Medicine. https://doi.org/10.1101/2020.10.03.20202275