A Randomised Trial Comparing Supraclavicular Block vs Supraclavicular and Pecs II Block in Arteriovenous Grafting

Changi General Hospital

Status: Completed

Conditions: Renal Failure, End-stage; Arteriovenous Graft; Arteriovenous Fistula; Kidney Failure, Chronic

Treatments: Procedure: Pecs II block; Procedure: Sham block (Grade 1); Procedure: Supraclavicular; Drug: Ropivacaine 0.5% 20ml; Drug: Ropivacaine 0.5% 10ml

Study type: Interventional

Funder types: Other

Identifiers

NCT02331030

2014/2047

Details and patient eligibility

About

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).

Full 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.

Enrollment: 36 patients

Sex: All

Ages: 21 to 90 years old

Volunteers: No Healthy Volunteers

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)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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36 participants in 2 patient groups

Combined (C)

Experimental group

Description:

Ultrasound-guided supraclavicular brachial plexus block with Ropivacaine 0.5% 20ml and Pecs II block with Ropivacaine 0.5% 10ml.

Treatment:

Procedure: Supraclavicular

Drug: Ropivacaine 0.5% 10ml

Procedure: Pecs II block

Drug: Ropivacaine 0.5% 20ml

Supraclavicular (S)

Active Comparator group

Description:

Ultrasound-guided supraclavicular BPB with Ropivacaine 0.5% 20ml and sham block (grade 1)

Treatment:

Procedure: Sham block (Grade 1)

Procedure: Supraclavicular

Drug: Ropivacaine 0.5% 20ml