Adding a PECS II block for proximal arm arteriovenous access - a randomised study

Area of Science:

• Regional Anesthesia
• Surgical Anesthesia
• Pain Management

Background:

• Brachial plexus blocks are standard for proximal arm arteriovenous access.
• Inadequate anesthesia in the medial upper arm and axilla often necessitates supplementation or general anesthesia.
• The Pectoralis Block (PECS) II block is explored to enhance anesthesia coverage.

Purpose of the Study:

• To evaluate if a PECS II block improves anesthesia and analgesia during proximal arm arteriovenous access surgery.
• To determine the efficacy of combined supraclavicular and PECS II block versus supraclavicular and sham block.

Main Methods:

• Prospective, double-blinded, randomized study of 36 end-stage renal disease patients.
• Groups: Combined supraclavicular + PECS II block (n=18) vs. supraclavicular + sham block (n=18).
• Primary outcome: Intraoperative local anesthetic supplementation requirement.

Main Results:

• 33.3% of PECS II group required supplementation vs. 100% in the sham group (RR 3.0, P < 0.001).
• PECS II group required significantly less supplemental local anesthetic (0.0 ml vs. 15.0 ml).
• The sham group had double the risk of needing additional sedation/analgesia (RR 2.2, P = 0.019).

Conclusions:

• Adding a PECS II block to supraclavicular block enhances regional anesthesia for this surgery.
• PECS II block reduces the need for intraoperative anesthetic supplementation.
• This technique offers improved anesthesia for patients undergoing proximal arm arteriovenous access surgery.