Efficacy and Safety of Ultrasound-Guided Supraclavicular Brachial Plexus Block during Angioplasty of Dysfunctional Arteriovenous Access: A Prospective, Randomized Single-Center Clinical Trial

Abstract

Purpose: To evaluate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block (BPB) during angioplasty of dysfunctional arteriovenous access.Materials and Methods: Eighty study participants with dysfunctional arteriovenous access were enrolled in this prospective, randomized clinical trial between November 2016 and February 2018. Eighty patients were randomized to either the ultrasound-guided supraclavicular BPB group (mean age ± standard deviation [SD], 65.1 ± 12.4; male:female ¼ 17:23) or the no regional anesthesia group (mean age ± SD, 64.0 ± 11.7; male:female ¼ 25:15). Pain was assessed on the 10-point Visual Analogue Scale. Participant satisfaction was examined. Six-month clinical follow-up was done to evaluate arteriovenous access patency and long-term complications.Results: The BPB group showed a lower average pain score than the control group (mean ± SD, 0.9 ± 1.9 vs 6.4 ± 2.5; P < .001). Participant satisfaction (mean ± SD, 2.8 ± 0.5 vs 2.1±0.8; P < .001) was also higher in the BPB group. Six-month patency was 65% (26/40) in the BPB group and 59% (23/39) in the control group, with no significant difference between the 2 groups (P ¼ .59). No major immediate or delayed complications were observed.Conclusions: Ultrasound-guided BPB is highly effective in reducing pain during angioplasty of dysfunctional arteriovenous access with an acceptable safety profile.

Anesthetic effect of ultrasound-guided block of the musculocutaneous nerve during endovascular treatment of dysfunctional radiocephalic arteriovenous fistulas

“…Previous reports have investigated the pain-suppressing effect of supraclavicular BPB for the EVT of dysfunctional hemodialysis access. 4,5 The supraclavicular BPB, frequently used for orthopedic surgeries in the upper limb distal to the shoulder, understandably achieved effective anesthesia with total motor paralysis of the upper limb, also known as the “dead arm.” 4,5,18 Such extreme anesthetic invasiveness merely for the EVT could be reduced with US-guided selective blocks, which are performed at the axilla and/or more distal sites, of the nerves innervating the cutaneous regions where stenotic runoff veins run. Chiba et al 19 blocked the MCN and RN, which provide sensory perception to the anterolateral and dorsolateral area of the forearm, respectively, at the axilla for malfunctioning AVF in the forearm and reported effective analgesia with motor paralysis.…”

“…4,5 The supraclavicular BPB, frequently used for orthopedic surgeries in the upper limb distal to the shoulder, understandably achieved effective anesthesia with total motor paralysis of the upper limb, also known as the "dead arm." 4,5,18 Such extreme anesthetic invasiveness merely for the EVT could be reduced with US-guided selective blocks, which are performed at the axilla and/or more distal sites, of the nerves innervating the cutaneous regions where stenotic runoff veins run. Chiba et al 19 blocked the MCN and RN, which provide sensory perception to the anterolateral and dorsolateral area of the forearm, respectively, at the axilla for malfunctioning AVF in the forearm and reported effective analgesia with motor paralysis.…”

“…2,3 Among these, complete supraclavicular BPB, which also induces motor paralysis, indisputably eradicates the pain during EVT; however, such deep anesthesia should be avoided in outpatient clinic-based treatments. 4,5…”

“…2,3 Among these, complete supraclavicular BPB, which also induces motor paralysis, indisputably eradicates the pain during EVT; however, such deep anesthesia should be avoided in outpatient clinic-based treatments. 4,5 We have previously reported anesthesia by ultrasound (US)-guided block of selective sensory nerves innervating the operative and procedural areas during surgery and EVT for VA in the upper limb. 6,7 Cutaneous sensory innervation in the forearm is delivered through the cutaneous nerve branches derived from the musculocutaneous nerve (MCN), medial antebrachial cutaneous nerve (MACN), and radial nerve (RN), which dominate the sensory innervation in the anterolateral, anteromedial, and posterodorsal areas in the forearm, respectively.…”

Sedoanalgesia with intravenous midazolam and fentanyl for angioplasty of dysfunctional arteriovenous access: A retrospective single-center analysis

“…There is also a possibility of unexpected intravenous infusion of the tumescent local anesthetic as well as achieving insufficient levels of analgesia. 3,4 Regional anesthesia, nerve block, is an alternative anesthetic method for PTA [4][5][6] . However, brachial plexus block is dependent on the skills of the anesthesiologist.…”