Ultrasound-guided supraclavicular versus infraclavicular brachial plexus nerve block in chronic renal failure patients undergoing arteriovenous fistula creation

Abstract

BackgroundMost patients with chronic renal failure suffer from complications that make brachial plexus block a good choice for providing anesthesia. The use of ultrasonography increases the success rate and decreases complications. We compared the efficacy of ultrasound-guided supraclavicular and infraclavicular brachial plexus block in providing anesthesia for creation of arteriovenous fistula.Patients and methodsSixty adult patients with chronic renal failure, scheduled for creation of arteriovenous fistula of the distal upper extremity were randomly divided into two equal groups: Supra G (n = 30): ultrasonic guided supraclavicular brachial plexus block was given and Infra G (n = 30): ultrasonic guided infraclavicular brachial plexus block was given. For both groups we used 20–25 cm 1:1 volumes of 0.5% bupivacaine and 2% lidocaine. The measured parameters were block performance time and related pain, the degree and duration of sensory and motor block, patient discomfort, first call for analgesics, complications and the patient’s satisfaction.ResultsThere was no statistically significant difference between both groups as regard the block performance time, the block related pain, the degree of sensory and motor block in the areas supplied by the median, radial and musculocutaneous nerves at 10, 20 and 30 min. There was no statistically significant difference as regard the sensory block grade in the area supplied by the ulnar nerve at 10 min, but it was significantly higher in the Supra G than Infra G at 20 and 30 min. No statistically significant difference as regard the motor block grade in the area supplied by the ulnar nerve, the block duration, first call for analgesia, complications and patients’ satisfaction.ConclusionBoth approaches can provide satisfactory sensory and motor block, very good analgesia that extends for a long time postoperatively in patients with chronic renal failure undergoing creation of arteriovenous fistula.