Paravertebral Block With Brachial Plexus Block for Upper Arm Arteriovenous Fistula Surgery

Study Overview
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Brief Summary
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The primary goal of this quality improvement project is to find the optimal surgical conditions for patients undergoing upper arm arteriovenous graft surgery. Currently, there are two anesthetic techniques used in clinical practice. The goal is to standardize future practice and improve the care of patients postoperatively. The two techniques used in conjunction with a brachial plexus block are paravertebral nerve block and subcutaneous infiltration.

Detailed Description
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This study is designed to test the null hypothesis that paravertebral nerve block or subcutaneous infiltration provide similar operating conditions when combined with supraclavicular nerve block for upper arm arteriovenous fistula surgery. The results will help determine which approach to use and guide future research in this area.

Official Title
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The Effectiveness of Thoracic Paravertebral Block in Improving the Anesthetic Effects of Regional Anesthesia for Upper Extremity Arteriovenous Fistula Surgery

Conditions
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Regional Anesthesia Success

Intervention / Treatment
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* Procedure: Subcutaneous infiltration of intercostobrachial nerve
* Procedure: T2 paravertebral nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients (>18 years) undergoing upper limb arteriovenous fistula surgery at UNC Chapel Hill hospital Exclusion Criteria: Contraindication to regional anesthesia Significant peripheral neuropathy or neurological disorder of the upper extremity Cognitive or psychiatric condition that will interfere with patient assessment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Intercostobrachial nerve Infiltration<br>Preoperative infiltration of intercostobrachial nerve with 10ml of ropivacaine 0.5% | Procedure: Subcutaneous infiltration of intercostobrachial nerve<br>* Preoperative subcutaneous infiltration of intercostobrachial nerve with 10ml of 0.5% ropivacaine<br>|
| Active Comparator: Ultrasound guided T2 paravertebral block<br>Preoperative ultrasound guided T2 paravertebral nerve block with 10ml of ropivacaine 0.5% | Procedure: T2 paravertebral nerve block<br>* Preoperative ultrasound guided T2 paravertebral nerve block with 10ml of 0.5% ropivacaine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with Successful Regional Anesthesia | Success is considered a regional anesthetic without rescue analgesic medications (including surgeon administered local anesthetic) or conversion to general anesthesia | By end of surgery |