Key result
Ultrasound-guided supraclavicular block with 20 ml of 0.5% bupivacaine provided similar onset and success rates as 30 ml, but with shorter block duration and significantly fewer complications.
Why the study?
Does 30 ml of bupivacaine 0.5% compared to 20 ml improve block characteristics or success rate in chronic renal failure patients undergoing arterio-venous shunt surgery?
RCT (n=50)
Sealed envelope
Does 30 ml of bupivacaine 0.5% compared to 20 ml improve block characteristics or success rate in chronic renal failure patients undergoing arterio-venous shunt surgery?
For ultrasound-guided supraclavicular block in ESRD patients undergoing AV shunt surgery, 20 ml of 0.5% bupivacaine is as effective as 30 ml for block onset and success, but with fewer complications.
May support 20-ml volumes to reduce complications; leaves open confirmation via randomized trials before practice change.
Background: There are different anesthetic techniques for AVF (Arterio-venous fistula) creation as general anesthesia, regional anesthesia and local anesthetic infiltration. Sympathetic nerve block is produced by regional anesthesia which increases intraoperative venous diameter and vessel flow, both intra-operatively and for several hours post-operatively. Regional anesthesia can maintain adequate blood flow through the fistula post-operatively which can prevent thrombosis and fistula failure and is important in fistula maturation. Aim: The aim of this study was to evaluate the effect of two different volumes of bupivacaine in chronic renal failure patients with ultrasound-guided supraclavicular brachial plexus block in arterio-venous shunt creation surgery. Methods: Patients were randomly classified using sealed envelope into two equal groups each of 25 patients; Group I: Patients received plain bupivacaine 0.5% (30 ml), Group II: Patients received plain bupivacaine 0. 5% (20 ml) In all groups, we measured the onset of sensory block, the onset of motor block, success rate , duration of motor and sensory block and complications. Results: Insignificant difference between both groups according to onset of sensory block, insignificant difference between both groups according to onset of motor block, Significant prolongation in duration of sensory block in group I as compared to group II, significant prolongation in duration of motor block in group I as compared to group II. There was significant increase in the rate of complications in group I as compared to group II and there was no significant difference between the two groups as regard the success rate. Conclusion: During ultrasound guided supraclavicular block in end stage renal disease (ESRD), administration of 20 ml bupivacaine 0.5% is equal to 30 ml bupivacaine 0.5% as regard the onset of sensory block, motor block and the success rate but with shorter duration as regard the sensory block and motor block and significant decrease in complications.
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Mogahed et al. (2017) conducted an RCT in Chronic renal failure / End stage renal disease (n=50). Ultrasound-guided supraclavicular brachial plexus block with plain bupivacaine 0.5% vs. Plain bupivacaine 0.5% (20 ml) was evaluated on Onset and duration of sensory and motor block, success rate, and complications. Ultrasound-guided supraclavicular block with 20 ml of 0.5% bupivacaine provided similar onset and success rates as 30 ml, but with shorter block duration and significantly fewer complications.
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