{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:26:12Z","timestamp":1790749572959,"version":"4.1.0"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"\n Background:<\/jats:title>\n Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%).<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jmu.jmu_125_22","type":"journal-article","created":{"date-parts":[[2024,3,23]],"date-time":"2024-03-23T01:00:05Z","timestamp":1711155605000},"page":"139-142","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of the Characteristics and Intricacies of Arrangement of Neural Elements in the Costoclavicular Block Using Ultrasound: A Retrospective Qualitative Study"],"prefix":"10.4103","volume":"32","author":[{"given":"Sandeep","family":"Diwan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anju","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parag","family":"Sancheti","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhuri","family":"Dadke","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"R1-20260505","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/AAP.0000000000000232","article-title":"Benefits of the costoclavicular space for ultrasound-guided infraclavicular brachial plexus block: Description of a costoclavicular approach","volume":"40","author":"Karmakar","year":"2015","journal-title":"Reg Anesth Pain Med"},{"key":"R2-20260505","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.5301\/jva.5000720","article-title":"Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery","volume":"18","author":"Beh","year":"2017","journal-title":"J Vasc Access"},{"key":"R3-20260505","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/AAP.0000000000000393","article-title":"Anatomic basis for brachial plexus block at the costoclavicular space: A cadaver anatomic study","volume":"41","author":"Sala-Blanch","year":"2016","journal-title":"Reg Anesth Pain Med"},{"key":"R4-20260505","doi-asserted-by":"crossref","first-page":"347","DOI":"10.4103\/ija.IJA_883_19","article-title":"Use of a pre-injection technique to identify neural elements in the costoclavicular space for brachial plexus block for upper limb orthopaedic surgery","volume":"64","author":"Parthasarathy","year":"2020","journal-title":"Indian J Anaesth"},{"key":"R5-20260505","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/AAP.0000000000000566","article-title":"Ultrasound-guided costoclavicular brachial plexus block: Sonoanatomy, technique, and block dynamics","volume":"42","author":"Li","year":"2017","journal-title":"Reg Anesth Pain Med"},{"key":"R6-20260505","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":"R7-20260505","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1177\/1558944720906510","article-title":"The 2-dimensional and 3-dimensional anatomy of the adult brachial plexus divisions and cords","volume":"17","author":"Neto","year":"2022","journal-title":"Hand (N 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blockade","volume":"34","author":"Monz\u00f3","year":"2021","journal-title":"Clin Anat"},{"key":"R12-20260505","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1007\/s12630-021-01990-8","article-title":"Critical structures in the needle path of the costoclavicular brachial plexus block: A cadaver study","volume":"68","author":"Bailey","year":"2021","journal-title":"Can J Anaesth"},{"key":"R13-20260505","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3340\/jkns.2009.46.2.130","article-title":"A morphometric aspect of the brachial plexus in the periclavicular region","volume":"46","author":"Lee","year":"2009","journal-title":"J Korean Neurosurg Soc"},{"key":"R14-20260505","doi-asserted-by":"crossref","first-page":"151751","DOI":"10.1016\/j.aanat.2021.151751","article-title":"A meta-analysis on the anatomical variability of the brachial plexus: Part I \u2013 Roots, trunks, divisions and cords","volume":"238","author":"Benes","year":"2021","journal-title":"Ann 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