• Eur J Anaesthesiol · Oct 2018

    Observational Study

    Assessing changes in tissue oxygenation by near-infrared spectroscopy following brachial plexus block for arteriovenous fistula surgery: A prospective observational pilot study.

    • Jonas Keuler, Carsten Weiß, Klaus Klemm, Julius Pochhammer, Rene Schmidt, and Christoph Ilies.
    • From the Department of Anaesthesiology and Intensive Care Medicine (JK, RS, CI), Department of Vascular and Endovascular Surgery (CW, KK), and Department of General, Visceral and Thoracic Surgery (JP), Marienhospital Stuttgart, Stuttgart, Germany.
    • Eur J Anaesthesiol. 2018 Oct 1; 35 (10): 759-765.

    BackgroundNear-infrared spectroscopy (NIRS) can be used to measure tissue oxygen saturation (StO2) in different sites and in a wide range of clinical scenarios. Peripheral regional anaesthesia induces vascular changes causing increased arterial blood flow and venodilatation, but its effect on StO2 is still under debate. This is especially so for patients undergoing arteriovenous fistula surgery, wherein latest data suggest an improved outcome under brachial plexus block (BPB) compared with local anaesthesia, but no data are available.ObjectiveThe aim of this study was to investigate changes in StO2 following BPB prior to arteriovenous fistula surgery using NIRS.DesignA prospective observational study.SettingA secondary teaching hospital from August 2016 to March 2017.PatientsFifteen patients undergoing arteriovenous fistula surgery.InterventionUltrasound-guided BPB in 15 patients undergoing arteriovenous fistula surgery.Outcome MeasuresStO2 at baseline and compared with baseline and the contralateral arm following BPB measured using NIRS of the thenar eminence (NIRSth).ResultsBaseline values of StO2 assessed by NIRSth were 42.6 ± 7.7% in the arteriovenous fistula arm and 42.7 ± 9.7% in the contralateral arm. There was no significant difference between the two. Five minutes after BPB, there was a significant increase in StO2 of the blocked arm, compared with the control arm expressed as difference of absolute values (7.1 ± 9.7%). At 60 min, an absolute difference of 21.0 ± 13.5% was reached. The absolute increase in StO2 of the blocked arm compared with baseline reached significance after 5 min (8.8 ± 4.6%) and increased up to 23.2 ± 8.2% after 60 min.ConclusionNIRSth indicates that BPB significantly increases StO2 of the arteriovenous fistula arm in patients undergoing haemodialysis.Trial RegistrationClinicaltrials.gov: NCT03044496.

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