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Supraclavicular Brachial Plexus Block for Creation of AV Fistula: Nerve Localization by Paraesthesia versus Electrical Nerve Locator

Reshma Balakrishnan, Assistant Professor, Department of Anaesthesiology, Pushpagiri Medical College And Research Centre, Thiruvalla, Kerala 689101, India. , Philip Mathew1 , Reshma Balakrishnan2 , Saritha Susan Vargese3

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Indian Journal of Anesthesia and Analgesia 5(9):p 1572-1577, September 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5918.23

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Abstract

Introduction: Regional nerve block anaesthesia offers many clinical advantages that contribute to improved patient outcome and lower healthcare costs.In patients with End Stage Renal Disease, a permanent vascular access through surgical construction of an arteriovenous fistula (AVF) is essential. However, many of these patients have severe comorbidities, which can lead to serious complications during general anesthesia.  Brachial plexus block attenuates the side effects of general anesthesia in patients undergoing AVF construction. Our aim was to compare two methods of nerve localisation – elicitation of paresthesia versus nerve locator with regards to technical feasibility and ease of nerve localization, onset and the time to establish complete surgical anaesthesia and to determine the success rate,quality of block and failure rate between the two methods.

Materials and Methods: A randomized controlled trial was conducted in to a near 1200 bed tertiary care hospital. The study population included patients who underwent AV fistula creation between a specified six months period. After obtaining written informed consent, patients fulfilling the study criteria were allocated randomly into two groups. Group (1) P – where nerve localization will be carried out by paresthesia technique. Group (2) PNL – where nerve localization will be done by peripheral nerve locator. The patients in both groups were monitored for the onset, duration, success or failure of block, sequelae and such other variables as required for fulfilling the objectives.

Results: In paresthesia group the time to localise the nerve was observed to be significantly less (p<0.05) as compared to the nerve locator group.The time for onset of block, latency of block, complete surgical analgesia, duration of surgical analgesia and postoperative analgesia did not show any statistical significance (p>0.05) between the paresthesia and nerve locator groups. The paresthesia group had nine cases and nerve locator group had four cases who required supplementation to achieve complete surgical analgesia. The success rate of nerve block was 91.1% in nerve locator group compared to 80% in paresthesia group.

Conclusion: Peripheral nerve locator appears to be more useful particularly when the block of deep seated plexus or nerves is desired. Although nerve locator may not help in improving the onset of block, latency of block or time to achieve complete surgical anaesthesia, the success ofperipheral nerve locator can be attributed to a lesser risk of tissue injuries like vascular punctures and direct nerve trauma.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5918.23

Keywords

Brachial Plexus Block; Paresthesia; Peripheral Nerve Locator.

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