Combined infraclavicular and axillary brachial plexus block for arteriovenous shunts using graft: a comparison study

ABSTRACT

This study was conducted to evaluate the extent and efficacy of combining infraclavicular and axillary brachial plexus block for arteriovenous shunt using graft versus performing each mentioned block alone. Eighty-two ASA III and IV patients were allocated randomly to receive either true axillary block [Hirshels' technique] [group I, 26 patients], or Infraclavicular block [group II, 28 patients], or combined Infraclavicular and Hirshels' axillary block [group III, 28 patients]. All patients received 40-50ml bupivacaine 0.375%. The extent and efficacy of anesthesia [nerve gaps] complications and duration of analgesia of all groups were recorded and analyzed. The three groups were comparable according to age, gender and weight. The duration of operations was 105_15 minutes, and 18-20 minutes after the completion of block all patients in the three groups demonstrated sufficient surgical anesthesia. Five patients from group I, three patients from group II and two patients from group III needed supplementation with xylocaine subcutaneously or with intravenous analgesics and sedatives [fentanyl 50mcg, ketamine 10-50mg with midazolam l-2mg] during incisions of lateral aspect of arm or forearm [musculocutaneous and radial nerve distribution or intercostobrachial nerves distribution]. Blood taps were recorded in three patients from group I. However, the combined group showed superior anesthesia regarding the three previously mentioned nerves compared with the single site blocks. Combined infraclavicular and axillary block anesthesia demonstrates an extensive sensory and motor block in comparison with performing the same blocks individually