This study evaluates the addition of Pecs II block to ultrasound-guided supraclavicular brachial plexus block in patients undergoing arteriovenous graft creation surgery. Participants will be randomised into two equal groups, one receiving supraclavicular and pecs II blocks, the other receiving supraclavicular block and sham block (Grade 1).
Regional anaesthesia (RA) for arteriovenous grafting surgery has advantages of avoiding risks of general anaesthesia (GA) in this group of patients with significant co-morbidities, and beneficial vasodilatation, which may prevent early fistula thrombosis. Hence, RA is preferable to GA for this surgery. Brachial plexus blocks (BPB) are the most commonly employed RA technique to anaesthetise the upper limb for this surgery. According to the results of a recent 2-year retrospective audit in our centre, ultrasound-guided supraclavicular BPB are the most popular RA technique for this surgery. Anatomically, the T1 and T2 dermatomes are often missed by the supraclavicular BPB. This means that the upper medial arm and axilla (sites involved in brachiobasilic and brachioaxillary arteriovenous grafting) may not be adequately anaesthetised, mandating intraoperative local anaesthetic supplementation by the surgeon. This may affect patients' and surgeons' acceptance of, and satisfaction with the RA technique. The ultrasound-guided Pecs II block, described by Blanco et al, seems to address this problem, as the intercostal T1-6, intercostobrachialis, long thoracic nerves and nerve to serratus anterior are targeted by this block.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
36
Ultrasound-guided supraclavicular brachial plexus block
Ultrasound guided interfascial plane block between pectoralis minor and serratus anterior
Sham block -- with skin preparation, ultrasound scanning of pecs II block area, but no actual needle injection
Changi General Hospital
Singapore, Singapore
Need for intraoperative local anaesthetic supplementation by the surgeon
Whether there was a need for the surgeon to infiltrate a standardised local anaesthetic drug (0.5% ropivacaine) to the operative site during surgery
Time frame: Intraoperative
Volume of intraoperative local anaesthetic supplementation administered
Total volume of local anaesthetic drug (0.5% ropivacaine) given by the surgeon
Time frame: Intraoperative
Need for additional sedation or systemic analgesia
Whether there was a need for additional sedation or systemic analgesia (on top of what is specified in the protocol)
Time frame: Intraoperative
Highest pain score at Post-Anaesthesia Care Unit (PACU)
Highest pain score on visual analogue scale at the post-anaesthesia care unit
Time frame: Up to 1 hour post-operatively
Time to first post-operative analgesia
Duration of time from administration of the block(s) to when patient first requests for oral analgesia. Participants will be followed up for 24 hours after surgery.
Time frame: Up to 24 hours post-operatively
Pain score at 12h
Pain score on visual analogue scale 12 hours after surgery
Time frame: 12 hours post-operatively
Pain score at 24h
Pain score on visual analogue scale 24 hours after surgery
Time frame: 24 hours post-operatively
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Local anaesthetic solution administered for supraclavicular block
Local anaesthetic solution administered for pecs II block
Patient satisfaction at 24hours
Patient satisfaction with the anaesthesia technique on a 5-point Likert scale 24 hours after surgery
Time frame: 24 hours post-operatively