Single-Injection Brachial Plexus Anesthesia for Arteriovenous Fistula Surgery of the Forearm: A Comparison of Infraclavicular Coracoid and Axillary Approach

Niemi, Tomi; Salmela, L.; Aromaa, U.; Pöyhiä, Reino; Rosenberg, P. H.

doi:10.1016/j.rapm.2006.09.010

Cited by 2 publications

(5 citation statements)

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“…However most sensory blocks become fixed at 30 min whereas motor distal blocks continue to progress. Niemi et al [ 18 ] evaluated the IBPB at 60 min after the injection of the block for the efficacy and found adequate surgical anesthesia ranging from 90% to 97% in the various nerve territories with absence of maximum block until 45 min. Delayed effect or evolving block even after 30 min could have resulted in partial effect in the patients receiving dexamethasone, particularly in the failed cases and cannot be ruled out since we waited only 30 min for the effect of the block.…”

Section: Discussionmentioning

confidence: 99%

“…Niemi et al ,[ 18 ] had observed mild tachycardia with ST segment depression in two patients who had received the axillary BPB, 10-15 min after the administration of local anesthetic. He suggested that the relative late appearance of symptoms were caused by absorption of epinephrine and attributed it to the large dose of epinephrine used (168-240 μg).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries

Shah

Arora

Trikha

et al. 2015

J Anaesthesiol Clin Pharmacol

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Background and Aims:The role of clonidine as an adjuvant to regional blocks to hasten the onset of the local anesthetics or prolong their duration of action is proven. The efficacy of dexamethasone compared to clonidine as an adjuvant is not known. We aimed to compare the efficacy of dexamethasone versus clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries.Material and Methods:Fifty three American Society of Anaesthesiologists-I and II patients aged 18-60 years scheduled for upper limb surgery were randomized to three groups to receive 1.5% lignocaine with 1:200,000 adrenaline and the study drugs. Group S (n = 13) received normal saline, group D (n = 20) received dexamethasone and group C (n = 20) received clonidine. The time to onset and peak effect, duration of the block (sensory and motor) and postoperative analgesia requirement were recorded. Chi-square and ANOVA test were used for categorical and continuous variables respectively and Bonferroni or post-hoc test for multiple comparisons. P < 0.05 was considered significant.Results:The three groups were comparable in terms of time to onset and peak action of motor and sensory block, postoperative analgesic requirements and pain scores. 90% of the blocks were successful in group C compared to only 60% in group D (P = 0.028). The duration of sensory and motor block in group S, D and C were 217.73 ± 61.41 min, 335.83 ± 97.18 min and 304.72 ± 139.79 min and 205.91 ± 70.1 min, 289.58 ± 78.37 min and 232.5 ± 74.2 min respectively. There was significant prolongation of sensory and motor block in group D as compared to group S (P < 0.5). Time to first analgesic requirement was significantly more in groups C and D as compared with group S (P < 0.5). Clinically significant complications were absent.Conclusions:We conclude that clonidine is more efficacious than dexamethasone as an adjuvant to 1.5% lignocaine in brachial plexus blocks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries

Shah

Arora

Trikha

et al. 2015

J Anaesthesiol Clin Pharmacol

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“…For the creation of an arteriovenous fistula for hemodialysis, succesful musculocutaneous nerve block is usually essential in order to provide adequate anesthesia as this nerve innervates the lateral aspect of the distal forearm. In cases where the exploration of blood vessels is extended distally, analgesia of the median and the radial nerve may also be required [3]. …”

Section: Discussionmentioning

confidence: 99%

“…In one study, Niemi et al [3] compared axillary approach and infraclavicular coracoid approach performed through single injection method for arteriovenous fistula surgeries in uremic patients. They reported that blockade of the musculocutaneous nerve developed faster with the infraclavicular coracoid approach than with the other and the infraclavicular coracoid approach may be preferable in patients scheduled for creation of an arteriovenous fistula at the forearm.…”

Section: Discussionmentioning

confidence: 99%

“…Previosuly, Niemi et al [3] compared axillary approach and infraclavicular coracoid approach performed through single injection method for arteriovenous fistula surgeries in uremic patients and at the end of their study, both approaches were reported to have similar efficacies. In this study, we aimed to compare the axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method in terms of sensory and motor block onset, quality, and extent of blocks of brachial plexus by the use of some local anesthetics volume containing a mixture of lidocaine and bupivacaine in equal amounts for arteriovenous fistula surgery in uremic patients.…”

Section: Introductionmentioning

confidence: 99%

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The Extent of Blockade Following Axillary and Infraclavicular Approaches of Brachial Plexus Block in Uremic Patients

2012

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IntroductionThis study was aimed to compare the axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method in terms of the sensory and motor block onset, quality, and extent of blocks of brachial plexus in uremic patients who underwent arteriovenous fistula surgery.MethodsForty patients scheduled for creation of arteriovenous fistula with axillary brachial plexus block (group AX, n = 20) or infraclavicular brachial plexus block (IC group, n = 20) were examined. The median, radial, ulnar, and musculocutaneous nerves were selectively localized by nerve stimulation. The volume of the local anesthetics was calculated based on the height of each patient, and the volume determined was prepared by mixing 2% lidocaine and 0.5% bupivacaine in equal proportions. Sensory and motor block were assessed at 3, 6, 9, 12, 15, 18, and 30th min and their durations were measured.ResultsWhile the adequate sensory and motor block rate with axillary approach was 100% in musculocutaneous, median, radial, ulnar and medial antebrachial cutaneous nerves, it was 65% in axillary nerve, 80% in intercostobrachial nerve and 95% in medial brachial cutaneous nerve. This rate was found to be 100% for all the nerves with infraclavicular approach.ConclusionFor arteriovenous fistula surgeries in uremic patients, both axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method can be used successfully; however, for the short performance of the procedure, infraclavicular block may be preferred.KeywordsBrachial plexus block; Axillary; Infraclavicular; Uremic patients

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Single-Injection Brachial Plexus Anesthesia for Arteriovenous Fistula Surgery of the Forearm: A Comparison of Infraclavicular Coracoid and Axillary Approach

Abstract: Blockade of the musculocutaneous nerve developed faster with the infraclavicular coracoid approach than with the axillary approach. The infraclavicular coracoid approach may be preferable in patients scheduled for the creation of an arteriovenous fistula at the forearm.

Cited by 2 publications

References 12 publications

Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries

Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries

The Extent of Blockade Following Axillary and Infraclavicular Approaches of Brachial Plexus Block in Uremic Patients

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