•      Ultrasound-guided supraclavicular (SC) and infraclavicular (IC) approaches have become increasingly common brachial plexus blocks (BPBs) for upper-extremity surgery, because of the greater safety of these methods due to real-time ultrasound guidance and faster onset times.

•      The occurrence of hemidiaphragmatic paresis depends on site of injection with the incidence being 45-100% for interscalene brachial plexus block, 28-67% for supraclavicular brachial plexus block and 13-24% for lateral sagittal infraclavicular brachial plexus block.

•      Hemidiaphragmatic paresis (HDP) is a frequent complication of the brachial plexus block, caused by unintentional blockade of the phrenic nerve, especially when the block is performed above the clavicle.

•      The costoclavicular brachial plexus block (CCB) is a recently introduced infraclavicular approach that targets three cords located lateral to the axillary artery in the costoclavicular space

•      The CCB can provide a successful and rapid onset of the blockade with a single injection of a relatively small volume of local anaesthetic.

•      The costoclavicular space is considered a retrograde channel to the supraclavicular area, enabling reliable anesthesia, same as supraclavicular block and also there are chances of hemidiaphragmatic paresis. However the incidence of hemidiaphragmatic paresis after costoclavicular block is not clearly known.

•       HDP can be easily tolerated in normal patients but it can cause complications in COPD patients. Hence our study to find out incidence of hemidiaphragmatic paresis after CCB will be useful.

•      As there are very few studies comparing the hemidiaphragmatic paresis after ultrasound- guided supraclavicular and costoclavicular brachial plexus block in elective upper limb surgeries, we would like to conduct this study comparing the two blocks.