Ultrasound-guided Supraclavicular Brachial Plexus Block with Ropivacaine in Basilic Vein Transposition Surgery for Chronic Renal Failure Patients: An Interventional Study

Abstract

Introduction: Basilic Vein Transposition surgery (BVT) is preferred under ultrasound-guided supraclavicular brachial plexus block, which provides excellent and safe anaesthesia in Chronic Renal Failure (CRF) patients. Ropivacaine, with a shorter elimination half-life than bupivacaine and better pharmacokinetics, is a safer option as a local anaesthetic agent in CRF. Aim: To assess the onset and duration of sensory and motor blockade with 20 mL of 0.5% ropivacaine in ultrasound-guided supraclavicular block and the need for additional local infiltration at the surgical site for BVT. Materials and Methods: In present interventional study conducted in the Department of Anaesthesiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, 25 American Society of Anaesthesiologists (ASA) III/IV CRF patients, aged 18-80 years, who underwent BVT surgery, were included from December 2021 to November 2022. A 20 mL dose of 0.5% ropivacaine was administered to these patients via ultrasound-guided supraclavicular block. The surgeon performed local infiltration with 10 mL of lignocaine at the T2 dermatomal area in all patients. Descriptive statistics were calculated for age, weight, ASA status, onset and duration of sensory and motor blockade, and the need for additional local infiltration. Results: The mean age and mean weight of the patients were 52 years and 57.68 kg, respectively. Total 17 were male and eight were female, while 23 were ASA III and two were ASA IV. After administering the supraclavicular block, the mean onset of sensory and motor blockade was 9±2.3629 and 13.16±2.6721 minutes, respectively. The mean duration of sensory and motor blockade was 612.8±132.815 and 522.8±121.124 minutes, respectively. All patients required local site infiltration (10 mL of 1% lignocaine-Adrenaline) as the T2 dermatome is usually spared by the supraclavicular block. Three patients required additional local anaesthetic infiltration. Conclusion: Minimising the concentration and volume of local anaesthetic drugs without compromising efficacy is challenging, particularly in BVT, where the incision is extensive and performed under supraclavicular BPB in high-risk CRF patients. The anaesthesia practice of using a low volume of 0.5% ropivacaine in BPB under ultrasound guidance, along with local anaesthetic infiltration with 1% lignocaine with adrenaline at the T2 dermatome, can serve this purpose without any complications.

Keywords

• anaesthesia
• dermatome
• interventional
• ultrasonography