Publication: Comparative study on efficacy of ultrasound guided supraclavicular versus costoclavicular brachial plexus block in patient for arteriovenous fistula surgery
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Date
2022
Authors
Noor, Nurul Izzati Mohd
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Abstract
Background: Most patients with end stage renal failure (ESRF) require placement of arteriovenous fistula (AVF) creation for receiving maintenance haemodialysis (HD). Most of them usually have multiple comorbidities that make brachial plexus block a good choice for providing anaesthesia and as an alternative to avoid general anaesthesia. This study objective is to compare the efficacy of ultrasound guided supraclavicular and costoclavicular brachial plexus block in providing anaesthesia for creation of AVF. Methods: 70 adult patients with ESRF, scheduled for creation of AVF of the distal upper extremity were randomly divided into two equal groups: supraclavicular brachial plexus block (Group SC, n = 35) and costoclavicular brachial plexus block (Group CC, n = 35). For both groups, 20 ml of 0.5% ropivacaine and 10ml of 1% lidocaine are used. The measured parameters were speed of onset of motor and sensory blockade, quality of blockade including procedural related pain score, the patient’s satisfaction and regional perfusion. Results: There were significant faster onset to achieve complete anaesthesia (p < 0.001), complete paralysis (p = 0.01) in all sensory and motor nerves in costoclavicular block compared to supraclavicular block. There were significant different of regional perfusion where there was higher perfusion in supraclavicular block compared to costoclavicular block (p=0.013). There were no significant differences in quality of block (p=0.573) and procedural related pain score (p = 0.117) between supraclavicular and costoclavicular brachial plexus block. Conclusion: Costoclavicular brachial plexus block is superior compared to supraclavicular approach in term of faster onset of sensory and motor blockade. For quality of block and procedural related pain score, costoclavicular brachial plexus block is comparable to supraclavicular brachial plexus block. We concluded that this new technique at costoclavicular brachial plexus block can be used as an alternative to supraclavicular approach for providing surgical anaesthesia in patients with ESRF undergoing creation of AVF.
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Keywords
costoclavicular brachial plexus block , supraclavicular brachial plexus block