The costoclavicular approach for infraclavicular perineural catheter placement is not superior to the paracoracoid approach for sensory blockade or analgesic effectiveness in ambulatory hand and wrist surgery.
In a randomized controlled trial of 139 adults undergoing ambulatory hand and wrist surgery, the costoclavicular (CC) approach resulted in successful sensory blockade at 48 hours in 42.6% of patients compared to 47.8% with the paracoracoid (PC) approach (adjusted risk difference -1.3%, 95% CI -17.5% to 15.0%). No clinically meaningful differences were observed in pain scores, opioid consumption, sleep quality, or patient satisfaction.
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The costoclavicular approach for infraclavicular perineural catheter placement is not superior to the paracoracoid approach for sensory blockade or analgesic effectiveness in ambulatory hand and wrist surgery. The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
The costoclavicular approach for infraclavicular perineural catheter placement is not superior to the paracoracoid approach for sensory blockade or analgesic effectiveness in ambulatory hand and wrist surgery.
This conclusion is most relevant to: Adults undergoing ambulatory hand and wrist surgery (n=139, 69 CC, 70 PC)..
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Comparison of costoclavicular and paracoracoid approaches for infraclavicular perineural catheter placement in outpatient hand and wrist surgeries: a randomized controlled trial. (Regional anesthesia and pain medicine, 2026) —
How It Works
The proposed biological pathway:
- ▸Costoclavicular approach targets tighter clustering of brachial plexus cords
- ▸Tighter clustering may improve local anesthetic spread
- ▸Standardized low-rate infusion of bupivacaine administered for 48 hours
- ▸Result: No significant difference in sensory blockade or analgesic effectiveness between CC and PC approaches
Who Might Benefit
Evidence fit by population:
- ▸Adults undergoing ambulatory hand and wrist surgery (n=139, 69 CC, 70 PC).
Recommended Dose
0.15% bupivacaine at 5 mL/hour for 48 hours
Limitations & Caveats
Important context when interpreting this evidence:
- ▸The study used a standardized low-rate infusion (5 mL/hour) which may not reflect optimal dosing for either approach
- ▸The primary outcome (successful sensory blockade at 48 hours) had a lower-than-expected success rate, potentially reducing statistical power
Frequently Asked Questions
What is the costoclavicular approach for infraclavicular catheters?▼
The costoclavicular (CC) approach is an ultrasound-guided technique for placing a continuous infraclavicular perineural catheter that targets the brachial plexus cords near the clavicle, aiming for tighter clustering of nerves to improve local anesthetic spread.
How was sleep quality measured in this study?▼
Sleep quality was assessed as a secondary outcome, but the abstract does not specify the exact measurement tool; it reports no clinically meaningful difference between the CC and PC groups.
What was the failure rate of sensory blockade in the study?▼
Successful sensory blockade at 48 hours occurred in 42.6% of the CC group and 47.8% of the PC group, meaning failure rates were 57.4% and 52.2%, respectively.
Does this study support using the costoclavicular approach over the paracoracoid approach?▼
No, the study found no evidence that the costoclavicular approach is superior to the paracoracoid approach for sensory blockade or analgesic effectiveness, suggesting technique selection can be based on operator preference.
References
- 1.Roy M, Carrier FM, Ferreira Guerra S, Garneau S, Harris P, Fournier N, Robin F. “Comparison of costoclavicular and paracoracoid approaches for infraclavicular perineural catheter placement in outpatient hand and wrist surgeries: a randomized controlled trial..” Regional anesthesia and pain medicine, 2026. PMID: 42457311 DOI: 10.1136/rapm-2026-107692