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

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Adding a Pectoralis Block (PECS) II block to supraclavicular block significantly reduced the need for supplemental anesthesia during proximal arm arteriovenous access surgery. This improved regional anesthesia for patients with end-stage renal disease.

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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.