{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:29:22Z","timestamp":1791908962627,"version":"4.3.4"},"reference-count":17,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,9,10]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background and objectives<\/jats:title>\n                  <jats:p>The costoclavicular brachial plexus block is performed deep and posterior to the midpoint of the clavicle. There are limited data evaluating the spread of the costoclavicular brachial plexus block. We performed a cadaveric study to evaluate the spread of injectate after a costoclavicular brachial plexus block.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Five ultrasound-guided costoclavicular block injections were performed with 20\u2009mL of 0.1% methylene blue. The brachial plexus and its branches were dissected from the level of C4 to the lower axilla. The extent of dye spread was recorded including spread to the phrenic nerve, suprascapular nerve, roots, trunks, divisions, cords and terminal branches of the brachial plexus.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The dye extended cephalad to the level of the cricoid cartilage in two of the five injections; three injections had dye extending 0.75\u2009cm, 1.5\u2009cm and 2\u2009cm caudad to the level of the cricoid cartilage, respectively. The C7, C8 and T1 nerve roots were stained in all injections. The dye did not extend cephalad to the C5 and C6 nerve roots. All trunks, cords and divisions of the brachial plexus were stained, as was the suprascapular nerve. There was no spread of dye to the phrenic nerve in any of the specimens.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This cadaveric study demonstrates that ultrasound-guided injection in the costoclavicular space spreads cephalad to the brachial plexus in the supraclavicular space, consistently reaching the suprascapular nerve and all trunks and cords of the brachial plexus, while sparing the phrenic nerve.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-101585","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T17:35:20Z","timestamp":1602005720000},"page":"31-34","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Evaluating the spread of costoclavicular brachial plexus block: an anatomical study"],"prefix":"10.1136","volume":"46","author":[{"given":"Veerandra","family":"Koyyalamudi","sequence":"first","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie R","family":"Langley","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4210-0942","authenticated-orcid":false,"given":"Monica W","family":"Harbell","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly B","family":"Kraus","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C","family":"Craner","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P","family":"Seamans","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Mayo Clinic, Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,10,6]]},"reference":[{"key":"2025090414280669000_46.1.31.1","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100055"},{"key":"2025090414280669000_46.1.31.2","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000529"},{"key":"2025090414280669000_46.1.31.3","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000232"},{"key":"2025090414280669000_46.1.31.4","first-page":"1303","article-title":"Sonographic mapping of the normal brachial plexus","volume":"24","author":"Demondion","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025090414280669000_46.1.31.5","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000393"},{"key":"2025090414280669000_46.1.31.6","doi-asserted-by":"crossref","DOI":"10.1097\/ALN.0000000000001724","article-title":"Costoclavicular space: a reliable gate for continuous regional anesthesia catheter insertion","volume":"127","author":"Garc\u00eda-Vitoria","year":"2017","journal-title":"Anesthesiology"},{"key":"2025090414280669000_46.1.31.7","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/EJA.0000000000001069","article-title":"Ipsilateral hemidiaphragmatic paresis after a supraclavicular and costoclavicular brachial plexus block: a randomised observer blinded study","volume":"36","author":"Sivashanmugam","year":"2019","journal-title":"Eur J Anaesthesiol"},{"key":"2025090414280669000_46.1.31.8","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3344\/kjp.2020.33.2.144","article-title":"Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study","volume":"33","author":"Oh","year":"2020","journal-title":"Korean J Pain"},{"key":"2025090414280669000_46.1.31.9","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.redar.2016.09.010","article-title":"Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion","volume":"64","author":"Nieuwveld","year":"2017","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"2025090414280669000_46.1.31.10","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000566"},{"key":"2025090414280669000_46.1.31.11","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-00115550-200811000-00006"},{"key":"2025090414280669000_46.1.31.12","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2019-100893"},{"key":"2025090414280669000_46.1.31.13","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3182660be2"},{"key":"2025090414280669000_46.1.31.14","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000629"},{"key":"2025090414280669000_46.1.31.15","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s12630-017-0842-z","article-title":"A randomized comparison between costoclavicular and paracoracoid ultrasound-guided infraclavicular block for upper limb surgery","volume":"64","author":"Leurcharusmee","year":"2017","journal-title":"Can J Anaesth"},{"key":"2025090414280669000_46.1.31.16","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198308000-00009"},{"key":"2025090414280669000_46.1.31.17","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2019-100852"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2020-101585","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T21:28:14Z","timestamp":1757021294000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2020-101585"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,6]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12,11]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/rapm-2020-101585"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2020-101585","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,6]]}}}