None listed
Conditions
Brief summary
Background and rationale Peripheral nerve blocks provide effective surgical anesthesia targeted to specific body regions while avoiding the unpleasant side-effects of general anesthesia. There are occasions when rapid and effective block reversal is needed. For example, interscalene brachial plexus block for upper extremity surgery frequently causes paralysis of the diaphragm due to inadvertent anesthesia of the phrenic nerve. A method to ‘wash out’ the local anesthetic around the phrenic nerve in these cases would be beneficial, Or in cases where patients are being discharged home the same day, and normal motor and sensory function of the limb in beneficial. Several studies have demonstrated that epidural washout using normal saline (NS) or Ringer’s lactate following epidural block facilitates more rapid recovery of motor function and sensation than letting the block resolve on its own. However, no studies to date have addressed whether washout is effective for reversal of peripheral nerve blocks. A recently published report suggests that a bolus of NS through a perineural catheter can rapidly and effectively restore phrenic nerve function following interscalene block. Study objective To demonstrate that infusion bolus of NS can be used in a clinical setting to modify the properties of a nerve block in patients who have received a nerve block for surgery and are expected to have minimal pain post operatively. Hypothesis We hypothesize that NS can be delivered through a perineural catheter to ‘wash out’ a nerve block to the point that function of the nerves returns. .
Interventions
Following completion of AV fistula surgery the patient is transferred to the recovery room. Here a recovery nurse will flush 10ml of normal saline down the peripheral nerve catheter every 15 minutes for one hour, in the intervention group, and the control group has nothing done to the catheter. A blinded observer then assesses the patients block, 4 times during the hour that the patient stays in recovery. They assess the motor and sensory function in the 4 major nerves of the arm, and assess
Following completion of AV fistula surgery the patient is transferred to the recovery room. Here a recovery nurse will flush 10ml of normal saline down the peripheral nerve catheter every 15 minutes for one hour, in the intervention group, and the control group has nothing done to the catheter. A blinded observer then assesses the patients block, 4 times during the hour that the patient stays in recovery. They assess the motor and sensory function in the 4 major nerves of the arm, and assess the pain scores of the patient.
Sponsors
Waikato hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Provide informed written consent • Adult (18 years or older) patients • Having AV fistula formation under brachial plexus block The patients block is measured on first admission to recovery room, and then every 15 minutes for one hour while in the recovery room. AV fistula patients are routinely discharged home after one hour in recovery.
Exclusion criteria
• Failure to provide informed consent • Infection at the needle insertion site • Known coagulopathy • Known allergy to local anesthetics • Presence of sensory or motor impairment in the distribution of the brachial plexus prior to nerve blockade • Inability to perform valid sensory or motor assessment due to impaired access to the limb, language barrier, or inability of the subject to co-operate with such examination
Outcome results
None listed