This study aims to determine whether ultrasound guided ESP block at 2nd thoracic vertebrae is non inferior to ultrasound guided ICBN block as adjunct to supraclavicular brachial plexus block in achieving complete sensory blockade of the medial upper arm during AVF superficialization
Arteriovenous fistula (AVF) superficialization is an essential procedure for patients with end-stage renal disease . The supraclavicular brachial plexus block is commonly used for upper extremity surgeries .Because the ICBN originates from the T2 nerve root below the C5-T1 nerve roots comprising the brachial plexus, brachial plexus blocks are ideally supplemented with an ICBN infiltration block for medial upper arm coverage.The ICBB requires precise ultrasound guidance to target the ICBN, which is small and variably located, making it technically challenging and time-intensive. ESP block at T2 level can provide broad coverage, ease of Performance, superficial injection and requiring less technical expertise compared to the ICBB . The patients are randomly allocated into 2 groups : 1. Erector spinae plane block group (Group ESP): will receive 10 ml of 0.5% bupivacaine injected into the erector spinae plane at T2 level under ultrasound guidance. 2. Intercostobrachial block group (Group ICBB): will receive 10 ml of 0.5% bupivacaine injected around intercostobrachial nerve under ultrasound guidance. • Standard Supraclavicular Brachial plexus Block will be performed for all patients using 20 ml of 0.5% bupivacaine under ultrasound guidance.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
110
1. Position: patient supine with arm abducted. 2. Ultrasound setup: High frequency probe positioned at upper axillary region. 3. Technique: Needle will be advanced into subcutaneous tissue, in-plane to target intercostobrachial nerve near axillary artery. 4. Drug: 10 ml of 0.5% bupivacaine.
1. Position: patient sitting or in lateral decubitus. 2. Ultrasound setup: High frequency linear transducer will be placed in a parasagittal 2-3 cm lateral to spinous process at T2 level, erector spinae muscles will be identified superficial to the tip of T2 transverse process, patient's skin anesthetized with 3 ml of 2 % lidocaine subcutaneously, the tip of the 22- gauge 80-mm block needle(Sonoplex, Pajunk Medical, Geisingen, Germany) needle will be placed into the facial plane on the deep (anterior) aspect of erector spinae muscle. location of needle tip will be confirmed by visible fluid spread lifting the erector spinae muscle off the bony shadow of the transverse process then 10 ml of 0.5% bupivacaine will be injected into the facial plane that will be confirmed by visible hydrodissection .
Aswan university hospital
Aswān, Egypt
Proportion of patients achieving complete sensory blockade during AVF superficialization
No discomfort and no need for sedation or conversion to general anesthesia
Time frame: baseline then at 15,30,60,120 minutes intraoperative assessment for vital signs and sensory blockade
Time to achieve complete sensory blockade.
How much time required to achieve complete sensory blockade in minutes
Time frame: Time for complete sensory blockade in minutes within 30 minutes
Patient's satisfaction (assessed using Likert scale).
Patient satisfaction was evaluated using a five-point Likert scale (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied)
Time frame: At the first 24 hours
Total opioid consumption in 24 hours
Total opioid consumption in 24 hours postoperative in mg /kg
Time frame: in the first 24 hours
The visual analog scale(VAS)
measure a patient pain intensty ,commonly used interpretation is 0:no pain,1-3 :mild pain.4-6:moderate pain,7-10 :sever pain
Time frame: in the first 12 hours
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