Renal Disease, Chronic
Conditions
Keywords
arteriovenous fistula operation, Infraclavicular nerve block, Near-infrared spectroscopy (NIRS), local anesthesia
Brief summary
In arteriovenous fistula surgery, the effect of infraclavicular brachial plexus block and local anesthesia on tissue oxygenation and the effect of primary patency of the AV fistula is intended to research.
Detailed description
It is planned to include patients who are American Society of Anesthesiologists (ASA) III and between the ages of 18-80 who will undergo arteriovenous fistula surgery in the research population.In our study, patients who come to the operating room for arteriovenous fistula operation will be randomly divided into two groups.Patients who undergo simple randomization with coin toss method will be assigned to one of two groups: group Local infiltrative anesthesia (Local) and group infraclavicular brachial plexus block with 0.25% bupivacaine (Block). Local infiltrative anesthesia will be applied with 15 ml 2% prilocaine for group Local patients.For Group Block patients, 30 ml 0.25% bupivacaine will be applied with Infraclavicular approach around brachial plexus with inplane technique.Before the start of surgery, NIRS probes will be placed on the thenar ,antecubital regions of both hands and arms .The preoperative observed values and data of every 5 minutes during the operation will be recorded .
Interventions
DEVICENIRS
Near Infra-Red Spectroscopy (NIRS) is a non-invasive monitoring modality which measures regional tissue oxygenation defined as percentage (%).
OTHERPinprick Test
With the pinprick test, the practitioner gently touches the skin with the pin and asks the patient whether it feels sharp or blunt .Test begins distally and then move proximally (aiming to test each dermatome and each main nerve). Assessment of sensorial blockade uses 3 grade system. Grade 0.Sharp pain Grade 1.Analgesia ,numbness Grade 2.Anesthesia ,no feeling
OTHERModified Bromage Scale
Assessment of motor blockade uses 4 point Modified Bromage Score. 0.Normal motor function with full extension and flexion of elbow, wrist and fingers 1. Decreased motor strengths with ability to full flexion elbow and move fingers but inability to raise arm 2. More decreased motor strengths with inability to move elbow but ability to move fingers 3.Complete motor block with inability to move elbow, wrist, and fingers.
DRUGBupivacaine
Bupivacaine is a potent local anesthetic with unique characteristics from the amide group of local anesthetics.
DRUGPrilocaine
Prilocaine is an amide local anesthetic secondary amine with an intermediate length of duration and quick onset of action.
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
NONE
Intervention model description
NIRS probes will be placed on the thenar, antecubital regions of both hands and arms .The preoperative observed values and data of every 5 minutes during the operation will be recorded.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* ASA III * 18-80 years old * arteriovenous fistula operation
Exclusion criteria
* disabled patients * mentally retarded * patients with coagulopathy * hemoglobinopathy * patients with infection in the infraclavicular area * local anesthetic history * peripheral neuropathy * peripheral arterial occlusion * failed peripheral nerve block
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| tissue oxygenation | beginning and every 5 minutes till the end of surgery | To compare the effects of infraclavicular brachial plexus block and local infiltrative anesthesia on tissue oxygenation during arteriovenous fistula (AVF) surgeries. Near Infra-Red Spectroscopy (NIRS) is a non-invasive monitoring modality which measures regional tissue oxygenation defined as percentage (%).Before surgery, NIRS probes will be placed on the thenar, antecubital regions of both hands and arms . |
| primary patency of the arteriovenous fistula | 1 month after the operation | To compare the effects of infraclavicular brachial plexus block and local infiltrative anesthesia on the primary patency of the arteriovenous fistula |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 5 Point Likert Scale | at the end of the operation | Surgeon and patient satisfaction will be evaluated by 5 Point Likert Scale at the end of surgery. 1 point:Dissatisfaction; 5 point:Fully satisfied |
Countries
Turkey (Türkiye)
Outcome results
None listed