Arteriovenous Fistula, Hemodialysis, Major Lower Limb Orthopedic Surgery, Stellate Ganglion Block
Conditions
Brief summary
The aim of this study is to evaluate the role of stellate ganglion blockade (SGB) for preserving arteriovenous fistula in hemodialysis patients undergoing major lower limb orthopedic surgery.
Detailed description
The best way for dialysis in chronic renal failure (CRF) patients with consideration of feasibility, rate of infection, and patency is hemodialysis by using native access by using arteriovenous fistula (AVF). Altered calcium and phosphor metabolism in CRF patients would also increase vascular reactivity. Stellate ganglion blockade (SGB) has been used for several years for both diagnosis and treatment of circulatory problems in upper extremity. Recently preemptive SGB has been used in prevention of radial artery spasm in coronary artery patients. SGB increases blood flow and decrease vascular resistance in the arm. SGB prevents or ameliorates the reactivity of the muscular layer of the RA in response to both surgical manipulation during harvesting the artery and to the potent vasoconstrictor mediators released during surgery
Interventions
DRUGStellate ganglion block
Patient will receive preemptive stellate ganglion block (SGB) just before spinal anesthesia.
Sponsors
Aswan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 21 to 75 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status III. * Chronic renal failure (CRF) patients. * Undergoing major lower limb orthopedic surgery.
Exclusion criteria
* Psychiatric disorders. * History of substance abuse. * Ipsilateral brachial and radial artery stenosis. * Allergy to local anesthetics. * Cardiovascular and respiratory disorders. * Coagulopathy. * Use of vasoactive medications. * Obesity (body mass index \>30 kg/m2). * Smoking.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fistula flow rate | 7th day postoperatively | Flow rate will be measured on the first day postoperative then on the 7th day. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Peak systolic velocity (PSV) | 7th day postoperatively | Peak systolic velocity (PSV) will be measured from radial artery 2 cm. proximal to fistula site, on the first day postoperative then on the 7th day. |
| End diastolic velocity (EDV) | 7th day postoperatively | End diastolic velocity (EDV) will be measured from radial artery 2 cm. proximal to fistula site, on the first day postoperative then on the 7th day. |
| Incidence of failure | 7th day postoperatively | Incidence of failure will be measured on the first day postoperative then on the 7th day. |
| Adverse effects | 7th day postoperatively | Postoperative adverse reactions such as hematoma, infection, thrombosis, bleeding, and pitosis will be recorded in both groups. |
Countries
Egypt
Contacts
Primary ContactAyman M Eldemrdash, MD
Outcome results
None listed