Response to comments: Pre-injection technique to identify neural elements in the costoclavicular space for brachial plexus block: Where and what to inject?

Sir,

We read with interest the comments raised by Ravi R and co-authors[1] regarding our publication on the easy visibility of costoclavicular space. The principal concern about costoclavicular block is the identification of plexus even though there are a lot of described advantages. The depth of the space and the proximity to vessels make its access unfriendly and unsafe especially to learners. Hence, we adopted this pre-injection technique in the supraclavicular space that is easily identifiable for injection.[2] The authors have commented about the possibility of hemidiaphragmatic weakness associated even with a dose of 5 ml. We reiterate that we had given only 3 ml. The suggestion of saline injection is well taken. Instead of a pre-injection in the costoclavicular space, we can suggest the same saline in the supraclavicular space to weed out any fear of phrenic nerve involvement. The very purpose of our finding and suggestion to make costoclavicular technique easier will stand defeated by the suggestion given, as they have proposed the pre-injection itself in the costoclavicular space. Still, we accept the recommendation of saline instead of a local anaesthetic drug.

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