Korean J Anesthesiol.  2023 Oct;76(5):442-450. 10.4097/kja.22718.

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

• Koo CH
• Hwang I
• Shin HJ
• Ryu JH

• KMID: 2548308
• DOI: http://doi.org/10.4097/kja.22718

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.

Keyword

Costoclavicular brachial plexus block; Hemidiaphragmatic paralysis; Infraclavicular approach; Meta-analysis; Nerve block; Upper limb surgery