Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial.

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For shoulder surgery, distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than the interscalene block (ISB). However, these approaches still show a high incidence of HDP. Recently, the costoclavicular block (CCB) has emerged as a promising technique that could provide effective analgesia while reducing HDP. We hypothesized that CCB would decrease the incidence of HDP compared to ISB, while still providing effective pain relief after surgery. Seventy patients undergoing arthroscopic rotator cuff repair were randomly allocated to receive ultrasound-guided CCB (n = 35) or ISB (n=35). Each group was received a 0.2% ropivacaine (CCB=20ml, ISB=10ml). The primary outcome was the incidence of HDP as a measured by M-mode ultrasound. And diaphragmatic excursion, pulmonary function test, opioid consumption and pain score were evaluated. Sixty-six patients were completed and analyzed. The CCB group had a significantly lower incidence of HDP compared with the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.84±2.24) group than the CCB (0.5±1.22) group (P < 0.001). The decrease in FVC and FEV1 from baseline was significantly greater in the ISB. And there was no significant difference in the opioid consumption during the entire postoperative period between the two groups. Compared to ISB, CCB significantly reduces the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB can be considered a viable option for diaphragmatic-sparing analgesia after shoulder surgery.