The Use of NIRS in Brachial Plexus Block
Condition: Arterio-venous Fistula
MeSH terms: Arteriovenous Fistula; Fistula
Study type: Interventional

Summary: 
      The study is planed on ASA I-III, 18-80 years old 60 patients developing chronic renal
      failure and needing arteriovenous fistula surgery for dialysis program in Istanbul Medeniyet
      University Goztepe Research Hospital. Informed consent of the patients will be obtained
      before surgery.Patients with hemoglobinopathy, coagulopathy, wound or infection in the thenar
      eminence, wound and infection in the supraclavicular region on the side of the regional
      block, allergic to local anesthetic drugs and mental retardation will not be included in the
      study.

      Standart monitorization (ECG, peripheral oxygen saturation and non-invasive arterial pressure
      monitoring) will be made. Base and 5 minutes interval values will be recorded until the end
      of the surgery. The pads of the NIRS monitor will be placed on the thenar eminence of both
      hands and fixed with the help of a draipe and basal measurements will be taken and recorded.
      The patients will then be divided into two groups according to computer-generated table of
      random numbers.

      Group L patients will undergo surgical cleansing and sterile draping and infiltrate %5
      bupivacaine 15ml. Group B the supraclavicular areas of the patients who will undergo surgical
      procedures will be sterile covered after appropriate sterilization. After the brachial plexus
      is visualized around the subclavian artery in the supraclavicular region with the help of
      Samsung ultrasound device, Bupivacaine 5% 20ml and Lidocaine 2% 10ml will be applied around
      the brachial plexus using a 50mm stimuplex needle. The effectiveness of the block will be
      evaluated by a single investigator after withdrawal of the needle, either by effective
      anesthesia with the block or every 10 minutes up to 30 minutes. The sensory block will be
      evaluated with a 3 point scale and the motor block will be evaluated routinely before and
      after the modified bromage scale (scored between 0 and 4). After withdrawal of the treated
      needle, we will contact the relevant nerve dermatome with cold application (cold SF) and ask
      the patient to classify the degree of cold feeling from 0 to 3. Block will be considered
      unsuccessful if surgical block cannot be provided after 30 minutes or if the patient
      experiences pain at any time during the operation. The duration of anesthesia occurring after
      local infiltration of Group L and the sensory and motor blockade after group B stimulation is
      taken will be recorded. In both groups, NIRS values will be recorded at 5 minute intervals
      until the end of the case after local anesthetic application.

      Investigator will call the patients for primer patency of fistula one month after operation.
    


Intervention name(s): Near infrared spectroscopy
Intervention type(s): Device
Intervention description(s): It is used for detection of tissue oxygenation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science