Arteriovenous Fistula, Arteriovenous Graft, Kidney Failure, Chronic, Renal Failure, End-stage
Conditions
Keywords
brachio-axillary, brachio-basilic, interfascial plane block, Pecs II block, supraclavicular brachial plexus block
Brief summary
This study evaluates the addition of Pecs II block to ultrasound-guided supraclavicular brachial plexus block in patients undergoing arteriovenous graft creation surgery. Participants will be randomised into two equal groups, one receiving supraclavicular and pecs II blocks, the other receiving supraclavicular block and sham block (Grade 1).
Detailed description
Regional anaesthesia (RA) for arteriovenous grafting surgery has advantages of avoiding risks of general anaesthesia (GA) in this group of patients with significant co-morbidities, and beneficial vasodilatation, which may prevent early fistula thrombosis. Hence, RA is preferable to GA for this surgery. Brachial plexus blocks (BPB) are the most commonly employed RA technique to anaesthetise the upper limb for this surgery. According to the results of a recent 2-year retrospective audit in our centre, ultrasound-guided supraclavicular BPB are the most popular RA technique for this surgery. Anatomically, the T1 and T2 dermatomes are often missed by the supraclavicular BPB. This means that the upper medial arm and axilla (sites involved in brachiobasilic and brachioaxillary arteriovenous grafting) may not be adequately anaesthetised, mandating intraoperative local anaesthetic supplementation by the surgeon. This may affect patients' and surgeons' acceptance of, and satisfaction with the RA technique. The ultrasound-guided Pecs II block, described by Blanco et al, seems to address this problem, as the intercostal T1-6, intercostobrachialis, long thoracic nerves and nerve to serratus anterior are targeted by this block.
Interventions
PROCEDURESupraclavicular
Ultrasound-guided supraclavicular brachial plexus block
PROCEDUREPecs II block
Ultrasound guided interfascial plane block between pectoralis minor and serratus anterior
PROCEDURESham block (Grade 1)
Sham block -- with skin preparation, ultrasound scanning of pecs II block area, but no actual needle injection
Local anaesthetic solution administered for supraclavicular block
DRUGRopivacaine 0.5% 10ml
Local anaesthetic solution administered for pecs II block
Sponsors
Changi General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for arteriovenous grafting under regional anaesthesia in Changi General Hospital * American Society of Anaesthesiologists (ASA) physical status 3 to 4 * Elective or emergency surgery
Exclusion criteria
* Patients unable to give consent, unable to communicate or cooperate with simple instructions * Patients with regular consumption of strong opioids (eg. morphine, oxycodone) or steroids * Patients with allergy or contraindications to local anaesthetics or any of the drugs included in this study * Patients with pre-existing upper limb neurological deficits * Patients who refuse or are unsuitable for regional anaesthesia (eg. severely coagulopathic)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Need for intraoperative local anaesthetic supplementation by the surgeon | Intraoperative | Whether there was a need for the surgeon to infiltrate a standardised local anaesthetic drug (0.5% ropivacaine) to the operative site during surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Volume of intraoperative local anaesthetic supplementation administered | Intraoperative | Total volume of local anaesthetic drug (0.5% ropivacaine) given by the surgeon |
| Need for additional sedation or systemic analgesia | Intraoperative | Whether there was a need for additional sedation or systemic analgesia (on top of what is specified in the protocol) |
| Time to first post-operative analgesia | Up to 24 hours post-operatively | Duration of time from administration of the block(s) to when patient first requests for oral analgesia. Participants will be followed up for 24 hours after surgery. |
| Highest pain score at Post-Anaesthesia Care Unit (PACU) | Up to 1 hour post-operatively | Highest pain score on visual analogue scale at the post-anaesthesia care unit |
| Pain score at 24h | 24 hours post-operatively | Pain score on visual analogue scale 24 hours after surgery |
| Patient satisfaction at 24hours | 24 hours post-operatively | Patient satisfaction with the anaesthesia technique on a 5-point Likert scale 24 hours after surgery |
| Pain score at 12h | 12 hours post-operatively | Pain score on visual analogue scale 12 hours after surgery |
Countries
Singapore
Outcome results
None listed