Perfusion IndexCOSTO-RCTNCT07586670
Comparison of 90° and 120° Arm Positions in Costoclavicular Block
A study testing Costoclavicular Brachial Plexus Block in people with Perfusion Index and Upper Extremity Surgery, run by Ankara Etlik City Hospital.
Trial summary
The costoclavicular approach of the infraclavicular brachial plexus block is widely used for upper extremity surgeries due to its reliable anatomy and high success rates. Patient positioning, particularly the degree of arm abduction, may influence the spread of local anesthetic and the characteristics of the block. Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- Perfusion Index, Upper Extremity Surgery, Brachial Plexus Block
- What is being tested?
- Costoclavicular Brachial Plexus Block
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 106 participants
- Where
- No sites listed yet
- Study dates
- 15 May 2026to 27 Aug 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients aged between 18 and 80 years.
- Patients scheduled for elective upper extremity surgery (hand, wrist, forearm).
- Patients classified as ASA I-III.
- Patients who provide informed consent after being informed about the study.
Who cannot join
- History of previous surgery, scar tissue, tumor, or trauma that may alter brachial plexus anatomy.
- Presence of infection, hematoma, severe edema, burn, or open wound at the block application site.
- Known allergy to local anesthetics or other medications used in the study.
- Coagulopathy, use of anticoagulants, or platelet count < 100,000/mm³.
- History of peripheral neuropathy, neurological deficit, cervical radiculopathy, or CRPS.
- Pregnancy or breastfeeding.
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- Patients with BMI < 18 kg/m².
- Patients with BMI > 35 kg/m².
- Severe cardiac, pulmonary, renal, or hepatic failure.
- Mental retardation, communication difficulties, or lack of cooperation.
- Deformity, amputation, or large mass in the surgical extremity that may interfere with sensorimotor assessment.
- Preoperative significant sensory loss, motor weakness, or signs of neurological disease.
- Severe anemia (Hb < 9 g/dL) or polycythemia (Hb > 18 g/dL).
- Psychiatric disorders, substance abuse, or any condition that may interfere with study compliance.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Effect of Arm Abduction Degree ( 90° vs. 120° ) on Block Onset Time and Block Success in Costoclavicular Brachial Plexus Block in Patients Undergoing Hand, Wrist and Forearm Surgery: A Prospective Randomized Controlled Trial
The costoclavicular approach of the infraclavicular brachial plexus block is widely used for upper extremity surgeries due to its reliable anatomy and high success rates. Patient positioning, particularly the degree of arm abduction, may influence the spread of local anesthetic and the characteristics of the block. However, the optimal arm abduction angle during this procedure remains unclear.
This prospective randomized controlled trial aims to investigate the effect of two different arm abduction angles (90° and 120°) on block onset time and block success in patients undergoing hand, wrist, and forearm surgery under ultrasound-guided costoclavicular brachial plexus block.
Read more
Patients will be randomly assigned to one of two groups according to the degree of arm abduction. The primary outcome is block onset time. Secondary outcomes include block success, sensory and motor block characteristics, perfusion index changes, hemodynamic parameters, readiness for surgery at 15 and 20 minutes, block performance time, need for additional anesthesia, postoperative neurological evaluation at 4 and 24 hours, complications, and patient satisfaction.
The findings of this study are expected to provide evidence on optimal patient positioning to improve the effectiveness and reliability of ultrasound-guided costoclavicular brachial plexus block.
Read the detailed description
The costoclavicular approach is a recently described infraclavicular technique for brachial plexus block that provides reliable anesthesia for upper extremity surgeries. Due to the compact arrangement of the cords in the costoclavicular space, this technique has gained popularity for its high success rates and consistent anatomy. However, procedural factors such as patient positioning may influence the distribution of local anesthetic and the effectiveness of the block.
Arm abduction is known to alter the anatomical relationships within the infraclavicular region, potentially affecting needle visualization, spread of local anesthetic, and block characteristics. Despite its clinical relevance, there is limited evidence regarding the optimal degree of arm abduction during ultrasound-guided costoclavicular brachial plexus block.
This prospective randomized controlled study aims to compare two different arm abduction angles 90° and 120° in patients undergoing elective hand, wrist, and forearm surgery. After obtaining written informed consent, eligible patients will be randomly assigned into two groups according to the degree of arm abduction.
All procedures will be performed under ultrasound guidance using a standardized technique. The local anesthetic will be administered in the costoclavicular space, and block characteristics will be assessed systematically. The primary outcome is block onset time, defined as the time from completion of local anesthetic injection to the achievement of adequate sensory block for surgery.
Secondary outcomes include block success, sensory and motor block scores, perfusion index measurements, hemodynamic parameters, readiness for surgery at 15 and 20 minutes, block performance time, need for additional anesthesia or conversion to general anesthesia, early complications, postoperative neurological evaluation at 4 and 24 hours, and patient satisfaction assessed using a Likert scale.
The results of this study are expected to provide valuable evidence regarding optimal patient positioning and contribute to improving the clinical effectiveness and reliability of ultrasound-guided costoclavicular brachial plexus block.
- Being tested
- Costoclavicular Brachial Plexus Block
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Costoclavicular Brachial Plexus BlockProcedure or surgery
Ultra-sound Guided costoclavicular brachial plexus block performed for upper extremity surgery using a standard local anesthetic technique
| Study group | Role | What they receive |
|---|---|---|
| 90° Arm Abduction | Experimental | Patients receive ultrasound-guided costoclavicular brachial plexus block with the arm positioned at 90° abduction. Receives: Procedure: Costoclavicular Brachial Plexus Block |
| 120° Arm Abduction | Experimental | Patients receive ultrasound-guided costoclavicular brachial plexus block with the arm positioned at 120° abduction. Receives: Procedure: Costoclavicular Brachial Plexus Block |
What is being measured
The primary outcome is the main question the study is designed to answer.
Block Onset Time
Time from completion of local anesthetic injection to achievement of adequate sensory block sufficient for surgery, assessed by pinprick test.
Measured: Up to 30 minutes after block performance
Secondary outcomes (16)
Block Success
Successful completion of surgery without the need for additional anesthesia.
Measured: İntraoperative period
Sensory Block Score
Sensory block was assessed using a 3-point pinprick scale ( 0= normal sensation, 1= loss of pinprick sensation, 2= complete sensory block).
Measured: Baseline and at 5-minute intervals up to 20 minutes after block performance.
Motor Block Score
Motor block was assessed using a 3-point motor scale (0= normal motor function, 1= reduced motor strength, 20 complete motor block).
Measured: Baseline and at 5-minute intervals up to 30 minutes after block performance.
Perfusion Index
Perfusion index values measured using a Masimo pulse oximeter probe placed on the blocked upper extremity.
Measured: Baseline and at 5,10,15 and 20 minutes after block performance.
Readiness for Surgery
Proportion of patients ready for surgery at 15 and 20 minutes.
Measured: 15 minutes after block
Readiness for Surgery
Proportion of patients ready for surgery at 15 and 20 minutes
Measured: 20 minutes after block
Block Performance Time
Time required to perform the block.
Measured: During procedure ( min )
Need for Additional Anesthesia
Requirement for supplemental anesthesia or conversion to general anesthesia.
Measured: Intraoperative period
Complications
Early complications related to block
Measured: Up to 24 hours
Postoperative Sensory and Motor Function Assessment
Postoperative neurological evaluation including sensory and motor function examination of the blocked upper extremity to assess for neurological complications.
Measured: 4 hours after surgery
Postoperative Sensory and Motor Function Assessment
Postoperative neurological evaluation including sensory and motor function examination of the blocked upper extremity to assess for neurological complications.
Measured: 24 hours after surgery
Patient Satisfaction
Patient satisfaction assessed using a 5-point Likert scale, where 1 indicates very dissatisfied and 5 indicates very satisfied.
Measured: At the end of the surgery and 24 hours postoperatively
Hemodynamic Parametres
Heart rate
Measured: Baseline and at 5,10,15 and 20minutes after block performance
Systolic Blood Pressure
Systolic blood pressure values measured during and after block performance.
Measured: Baseline and at 5,10,15 and 20 minutes after block performance.
Diastolic Blood Pressure
Diastolic blood pressure values measured during and after block performance.
Measured: Baseline and at 5,10,15 and 20 minutes after block performance.
Mean Arterial Pressure
Mean arterial pressure values measured during and after block performance.
Measured: Baseline and at 5,10,15 and 20 minutes after block performance.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 May 2026
- Study start15 May 2026 (estimated)
- Primary completion15 Jul 2026 (estimated)
- Study completion27 Aug 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Perfusion IndexStudies of the same condition, open and under way.
- More trials run by Ankara Etlik City HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomly assigned to one of two parallel groups based on the degree of arm abduction (90° or 120°) during ultrasound-guided costoclavicular brachial plexus block. Outcomes will be compared between the two groups.
- Masking
- None (open label)
- Enrolment
- 106 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Ankara Etlik City Hospital
- Sponsor type
- Other government
- Responsible party
- Principal investigator, ALGAN TURGUT ÇARSANCAKLI, Ankara Etlik City Hospital
- Investigators
- Reyhan Polat, Professor, Study director, Ankara Etlik City Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07586670
- Sponsor's protocol ID
- AEŞH-EK-2026-07
- Acronym
- COSTO-RCT
- Status last verified
- Jun 2026
- First submitted
- 7 Apr 2026
- Last updated
- 9 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 9 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Arm Abduction Degree ( 90° vs. 120° ) on Block Onset Time and Block Success in Costoclavicular Brachial Plexus Block in Patients Undergoing Hand, Wrist and Forearm Surgery: A Prospective Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07586670
- Acronym / sponsor ID
- COSTO-RCT / AEŞH-EK-2026-07
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 106 participants (estimated)
- Lead sponsor
- Ankara Etlik City HospitalOther government
- Study start
- 15 May 2026 (estimated)
- Primary completion
- 15 Jul 2026 (estimated)
- Study completion
- 27 Aug 2026 (estimated)
- First posted
- 14 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The costoclavicular approach of the infraclavicular brachial plexus block is widely used for upper extremity surgeries due to its reliable anatomy and high success rates. Patient positioning, particularly the degree of arm abduction, may influence the spread of local anesthetic and the characteristics of the block. However, the optimal arm abduction angle during this procedure remains unclear.
This prospective randomized controlled trial aims to investigate the effect of two different arm abduction angles (90° and 120°) on block onset time and block success in patients undergoing hand, wrist, and forearm surgery under ultrasound-guided costoclavicular brachial plexus block.
Patients will be randomly assigned to one of two groups according to the degree of arm abduction. The primary outcome is block onset time. Secondary outcomes include block success, sensory and motor block characteristics, perfusion index changes, hemodynamic parameters, readiness for surgery at 15 and 20 minutes, block performance time, need for additional anesthesia, postoperative neurological evaluation at 4 and 24 hours, complications, and patient satisfaction.
The findings of this study are expected to provide evidence on optimal patient positioning to improve the effectiveness and reliability of ultrasound-guided costoclavicular brachial plexus block.
Detailed description
The costoclavicular approach is a recently described infraclavicular technique for brachial plexus block that provides reliable anesthesia for upper extremity surgeries. Due to the compact arrangement of the cords in the costoclavicular space, this technique has gained popularity for its high success rates and consistent anatomy. However, procedural factors such as patient positioning may influence the distribution of local anesthetic and the effectiveness of the block.
Arm abduction is known to alter the anatomical relationships within the infraclavicular region, potentially affecting needle visualization, spread of local anesthetic, and block characteristics. Despite its clinical relevance, there is limited evidence regarding the optimal degree of arm abduction during ultrasound-guided costoclavicular brachial plexus block.
This prospective randomized controlled study aims to compare two different arm abduction angles 90° and 120° in patients undergoing elective hand, wrist, and forearm surgery. After obtaining written informed consent, eligible patients will be randomly assigned into two groups according to the degree of arm abduction.
All procedures will be performed under ultrasound guidance using a standardized technique. The local anesthetic will be administered in the costoclavicular space, and block characteristics will be assessed systematically. The primary outcome is block onset time, defined as the time from completion of local anesthetic injection to the achievement of adequate sensory block for surgery.
Secondary outcomes include block success, sensory and motor block scores, perfusion index measurements, hemodynamic parameters, readiness for surgery at 15 and 20 minutes, block performance time, need for additional anesthesia or conversion to general anesthesia, early complications, postoperative neurological evaluation at 4 and 24 hours, and patient satisfaction assessed using a Likert scale.
The results of this study are expected to provide valuable evidence regarding optimal patient positioning and contribute to improving the clinical effectiveness and reliability of ultrasound-guided costoclavicular brachial plexus block.
Study design
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Participants will be randomly assigned to one of two parallel groups based on the degree of arm abduction (90° or 120°) during ultrasound-guided costoclavicular brachial plexus block. Outcomes will be compared between the two groups.
| Arm | Type | Receives |
|---|---|---|
| 90° Arm Abduction | Experimental | Procedure: Costoclavicular Brachial Plexus BlockPatients receive ultrasound-guided costoclavicular brachial plexus block with the arm positioned at 90° abduction. |
| 120° Arm Abduction | Experimental | Procedure: Costoclavicular Brachial Plexus BlockPatients receive ultrasound-guided costoclavicular brachial plexus block with the arm positioned at 120° abduction. |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Patients aged between 18 and 80 years.
- Patients scheduled for elective upper extremity surgery (hand, wrist, forearm).
- Patients classified as ASA I-III.
- Patients who provide informed consent after being informed about the study.
Key exclusion criteria (14 listed)
- History of previous surgery, scar tissue, tumor, or trauma that may alter brachial plexus anatomy.
- Presence of infection, hematoma, severe edema, burn, or open wound at the block application site.
- Known allergy to local anesthetics or other medications used in the study.
- Coagulopathy, use of anticoagulants, or platelet count < 100,000/mm³.
- History of peripheral neuropathy, neurological deficit, cervical radiculopathy, or CRPS.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Costoclavicular Brachial Plexus BlockUltra-sound Guided costoclavicular brachial plexus block performed for upper extremity surgery using a standard local anesthetic technique | Procedure or surgery | 120° Arm Abduction, 90° Arm Abduction |
Primary outcome
Block Onset Time
Time frame: Up to 30 minutes after block performance
Time from completion of local anesthetic injection to achievement of adequate sensory block sufficient for surgery, assessed by pinprick test.
16 secondary outcomes
Block Success
Time frame: İntraoperative period
Sensory Block Score
Time frame: Baseline and at 5-minute intervals up to 20 minutes after block performance.
Motor Block Score
Time frame: Baseline and at 5-minute intervals up to 30 minutes after block performance.
Perfusion Index
Time frame: Baseline and at 5,10,15 and 20 minutes after block performance.
Readiness for Surgery
Time frame: 15 minutes after block
Readiness for Surgery
Time frame: 20 minutes after block
Block Performance Time
Time frame: During procedure ( min )
Need for Additional Anesthesia
Time frame: Intraoperative period
Complications
Time frame: Up to 24 hours
Postoperative Sensory and Motor Function Assessment
Time frame: 4 hours after surgery
Postoperative Sensory and Motor Function Assessment
Time frame: 24 hours after surgery
Patient Satisfaction
Time frame: At the end of the surgery and 24 hours postoperatively
Hemodynamic Parametres
Time frame: Baseline and at 5,10,15 and 20minutes after block performance
Systolic Blood Pressure
Time frame: Baseline and at 5,10,15 and 20 minutes after block performance.
Diastolic Blood Pressure
Time frame: Baseline and at 5,10,15 and 20 minutes after block performance.
Mean Arterial Pressure
Time frame: Baseline and at 5,10,15 and 20 minutes after block performance.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Jun 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Reyhan Polat, Professor study director
Ankara Etlik City Hospital
Questions about this trial
What is this clinical trial studying?
A study testing Costoclavicular Brachial Plexus Block in people with Perfusion Index and Upper Extremity Surgery, run by Ankara Etlik City Hospital.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 9 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Algan TURGUT ÇARSANCAKLI, M.D. (+90 532 486 52 69, alganturgut@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Block Onset Time (time frame: Up to 30 minutes after block performance). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jun 2026.