الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
 |  | from | 61 |  |  |
| | | from | 61 | | |
Abstract
This study is a randomized control study done over (4) patients in sohag university hospital after approval of research ethics committee in faculty of medicine sohag university ,the patients were all candidates for brachio-cephalic shunt creation for purpose of hemodialysis, the patients were divided into two groups ,one group will be anesthetized through supraclavicular nerve block under sonographic guide and the other group will be anesthetized with with local infiltration anesthesia at surgical site
The aim of this study is to detect whether one method has priority over the other or not and whether one method will decrease failure rate in shunt post-operative
The procedure was done for group (A) through ultrasound guided supraclavicular nerve block using 0.375 concentration and 30 cc volume ,for group (B) by local infiltration of bupivacaine 0.375 concentration and 30 cc volume
Monitoring was done intraoperative (pulse ,blood pressure , ECG, spo2),pain was well observed , patient satisfaction and surgeon satisfaction, sedation was given according to patient needs ,4 hours post-operative all patients are transferred to the ultrasound room to perform duplex scan over the shunt and compare the results ,4 month post-operative patients are examined for shunt patency and palpable thrill and whether functioning or not
We found that patients who received nerve block were more calm ,pain free, need less sedation , more satisfied than patients who received local infiltration anesthesia .patients who received nerve block had more blood flow across the shunt by duplex scan .as regard shunt patency post-operative there was no significant difference between the two groups
Conclusion
According to the study that was previously shown we can say the following:
local infiltration of a local anesthetic agent at surgical site is a rapid maneuver ,it is also easy to perform and doesn’t need experience
nerve block for shunt creation will carry the following advantages over local infiltrative anesthesia : it improves the quality of block, less incidence of pain perception , less need for intraoperative sedation ,it will provide motor block ,will be more satisfactory to patient and surgeon ,it will give the patient a long period of post-operative analgesia
finally we can say that nerve block can enhance blood flow across the shunt in the 1st hours post-operative and this of course will give the shunt a better chance to survive and prevent early thrombosis ,although the long term patency of the shunt couldn’t be proved by the study, but for sure the enhanced blood flow across the shunt is a very important factor for shunt survival
we recommend that whenever the ultrasound is available with enough experience to use it nerve block is the anesthetic modality of choice for A-V shunt creation in patients with chronic renal failure,also we recommend that this study should be applied on a larger sample size and a longer period of post-operative follow up.