Preoperative Ultrasound Guided Thoracic Erector Spinae Plane Block Versus Costoclavicular Block for Shoulder Arthroscopy

Shoulder surgery is one of the most common orthopedic surgical procedures that causes severe pain . Pain management in such patients is very important because pain relief allows early mobilization, effective postoperative rehabilitation, and shorter hospitalization stays. Several regional anesthesia techniques have been used for pain management following shoulder surgery. Interscalene brachial plexus block (ISB) is the gold standard analgesic technique for shoulder procedures, but this method can lead to some serious complications, such as hemidiaphragmatic paralysis (HDP), Horner's syndrome, and hoarseness. The costoclavicular block (CCB) was introduced as infraclavicular approach, first described in 2015 , targets the brachial plexus in the costoclavicular space where its three cords are tightly clustered together lateral to the axillary artery and more superficially than with the classical approach of infraclavicular fossa . Recently, Garcia-Vittoria et al have suggested that the costoclavicular space could also serve as a retrograde channel to supraclavicular brachial plexus blocks, so if local anesthetic (LA) injected in the costoclavicular space can reliably reach the supraclavicular brachial plexus enabling reliable anesthesia including anesthesia to the suprascapular nerve during shoulder surgery, one could achieve analgesic parity with small-volume supraclavicular block (and ISB) while retaining the 0% incidence of HDP seen with infraclavicular blocks. Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016 (. It is an interfascial plane block, but it may be classified as a paraspinal block due to its mechanism of action and injection site