ESRD (End Stage Renal Disease)
Conditions
Keywords
AVF superficialization, Intercostobrachial block
Brief summary
This study aims to determine whether ultrasound guided ESP block at 2nd thoracic vertebrae is non inferior to ultrasound guided ICBN block as adjunct to supraclavicular brachial plexus block in achieving complete sensory blockade of the medial upper arm during AVF superficialization
Detailed description
Arteriovenous fistula (AVF) superficialization is an essential procedure for patients with end-stage renal disease . The supraclavicular brachial plexus block is commonly used for upper extremity surgeries .Because the ICBN originates from the T2 nerve root below the C5-T1 nerve roots comprising the brachial plexus, brachial plexus blocks are ideally supplemented with an ICBN infiltration block for medial upper arm coverage.The ICBB requires precise ultrasound guidance to target the ICBN, which is small and variably located, making it technically challenging and time-intensive. ESP block at T2 level can provide broad coverage, ease of Performance, superficial injection and requiring less technical expertise compared to the ICBB . The patients are randomly allocated into 2 groups : 1. Erector spinae plane block group (Group ESP): will receive 10 ml of 0.5% bupivacaine injected into the erector spinae plane at T2 level under ultrasound guidance. 2. Intercostobrachial block group (Group ICBB): will receive 10 ml of 0.5% bupivacaine injected around intercostobrachial nerve under ultrasound guidance. • Standard Supraclavicular Brachial plexus Block will be performed for all patients using 20 ml of 0.5% bupivacaine under ultrasound guidance.
Interventions
1. Position: patient supine with arm abducted. 2. Ultrasound setup: High frequency probe positioned at upper axillary region. 3. Technique: Needle will be advanced into subcutaneous tissue, in-plane to target intercostobrachial nerve near axillary artery. 4. Drug: 10 ml of 0.5% bupivacaine.
PROCEDUREUltrasound Guided Erector Spinae Plane Block at T2 level
1. Position: patient sitting or in lateral decubitus. 2. Ultrasound setup: High frequency linear transducer will be placed in a parasagittal 2-3 cm lateral to spinous process at T2 level, erector spinae muscles will be identified superficial to the tip of T2 transverse process, patient's skin anesthetized with 3 ml of 2 % lidocaine subcutaneously, the tip of the 22- gauge 80-mm block needle(Sonoplex, Pajunk Medical, Geisingen, Germany) needle will be placed into the facial plane on the deep (anterior) aspect of erector spinae muscle. location of needle tip will be confirmed by visible fluid spread lifting the erector spinae muscle off the bony shadow of the transverse process then 10 ml of 0.5% bupivacaine will be injected into the facial plane that will be confirmed by visible hydrodissection .
Sponsors
Fatma Hatem Mokhtar
Aswan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* • Adults scheduled for upper extremity surgeries under regional anesthesia. * Age: 18-65 years. * American society of Anesthesiologists (ASA) III. * Body Mass Index (BMI) \< 35 kg/m².
Exclusion criteria
* •Allergy to local anesthetics. * Coagulopathy or infection at injection sites. * Pre-existing neuropathy or significant psychiatric disorders. * Pregnant or lactating women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients achieving complete sensory blockade during AVF superficialization | baseline then at 15,30,60,120 minutes intraoperative assessment for vital signs and sensory blockade | No discomfort and no need for sedation or conversion to general anesthesia |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to achieve complete sensory blockade. | Time for complete sensory blockade in minutes within 30 minutes | How much time required to achieve complete sensory blockade in minutes |
| Patient's satisfaction (assessed using Likert scale). | At the first 24 hours | Patient satisfaction was evaluated using a five-point Likert scale (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied) |
| Total opioid consumption in 24 hours | in the first 24 hours | Total opioid consumption in 24 hours postoperative in mg /kg |
| The visual analog scale(VAS) | in the first 12 hours | measure a patient pain intensty ,commonly used interpretation is 0:no pain,1-3 :mild pain.4-6:moderate pain,7-10 :sever pain |
Countries
Egypt
Outcome results
None listed