| Comparison of the analgesic efficacy between the ultrasound-guided continuous costoclavicular brachial plexus block and ultrasound-guided continuous interscalene brachial plexus block: a randomized controlled non-inferiority trial |
Taotao Xing1, Lan Ge1,2, Da Zhong1, Shuo Chen1,2, Yongjie Li1,3, Hongjin Ni1,4, Yiqi Fang1,5, Yantian Lv1, HuaJie Mao6, Lina Yu1,7 
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1Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
2Department of Ophthalmology, The Second Hospital Affiliated, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
3Department of Anesthesiology, Jiande Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Jiande, Zhejiang, PR China
4Department of Anesthesiology, Hangzhou Traditional Chinese Medical Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR China
5Department of Anesthesiology, Chun’an County First People’s Hospital Hangzhou, Zhejiang, PR China
6Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
7Zhejiang Key Laboratory of Pain Perception and Neuromodulation, Hangzhou, PR China |
Corresponding author:
Lina Yu, Tel: +86 13958033387 ,
Email: zryulina@zju.edu.cn
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Received: 21 June 2025 • Revised: 23 September 2025 • Accepted: 24 September 2025
*Taotao Xing and Lan Ge contributed equally to this study as co-first authors. |
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| Abstract |
Background
The continuous interscalene brachial plexus block (ISB) is widely used for regional anesthesia in shoulder surgeries. Although the continuous costoclavicular brachial plexus block (CCB) has been proposed, its comparative efficacy and safety remain unclear. This randomized, single-blind trial aimed to determine whether the CCB offers non-inferior postoperative analgesia compared to the ISB while mitigating hemidiaphragmatic paresis (HDP).
Methods
patients underwent rotator cuff repair received continuous ISB or CCB followed by 0.2% ropivacaine infusion postoperatively. The primary outcome was the resting numerical rating scale (NRS) pain score 24 h postoperatively. Secondary outcomes included block-related parameters, dynamic and resting pain scores, HDP incidence, opioid consumption, rescue analgesia requirements, and satisfaction scores.
Results
Resting NRS scores at 24 h demonstrated the non-inferiority of the CCB compared to the ISB (2.41 ± 0.59 vs. 2.00 ± 0.81; mean difference: 0.41; 95% CI: 0.1–0.73). The CCB significantly reduced the incidence of early complete HDP (30 min post-block: 7.3% vs. 41.5%; P < 0.001), with no incidence of complete HDP at 24 h. The CCB had longer block times (19.2 ± 3.7 vs. 17.2 ± 3.6 min; P = 0.013) and sensory onet (24.0 [21.0–24.0] vs. 18.0 [18.0–21.0] min; P < 0.001). Total ropivacaine consumption, rescue analgesia, or satisfaction scores were comparable.
Conclusions
The continuous CCB is non-inferior to the ISB in terms of postoperative analgesia after rotator cuff repair and substantially decreases the risk of HDP. These findings support the CCB as a clinically advantageous alternative for shoulder surgery analgesia. |
| Key Words:
Brachial plexus; Continuous infusion; Nerve block; Postoperative analgesia; Regional anesthesia; Ultrasound-guided. |
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