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KMID : 1147320160030020035
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Journal of Surgical Ultrasound
2016 Volume.3 No. 2 p.35 ~ p.39
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Brachial Plexus Block and Vascular Evaluation Used Ultrasound in Arteriovenous Access Surgery
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Lee Jae-Hoon
Kwak Sang-Gyu
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Abstract
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Purpose: Brachial plexus block (BPB) promotes vasodilation of the upper extremities because of a sympathectomy-like effect. We investigated changes in the arteries and veins of the upper extremities after BPB, the factors affecting the vascular change of vessels and the relations with the patency of vascular access.
Methods: From September 2015 to February 2016, 49 patients evaluable by ultrasonography were included this study. The arteries and veins were examined prospectively before and after BPB at the wrist, cubital fossa and axilla fossa. A two sample t-test and paired t-test were used for statistical analyses.
Results: The mean age of the patients was 63.08 ± 14.23 years and the percentage of males was 67.3%. Artificial grafts were used in 23 patients (46.9%), supraclavicular BPB in 37 patients and axillary BPB in 12 patients. All vessels except axillary arteries increased significantly after BPB. In diabetic patients, changes in brachial arteries, brachial veins and axillary veins less increased (P = 0.04, 0.015 and 0.011). The level of anesthesia is most common to C7 dermatome after BPB (65%). The mean last follow-up period was 66.78 ± 52.50 days. Vascular access was occluded in four patients. The vascular access patency was not related to the sizes and changes in vessels. No other complications associated with BPB procedures were not noted except for phrenic nerve palsy in one patient.
Conclusion: BPB employing ultrasound was found to be an effective and safe procedure that could improve venous dilation and absence of arterial spasm in vascular access surgery. However, caution may be necessary in selecting veins for vascular access in diabetic patients having less venous dilatation.
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KEYWORD
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Brachial plexus anesthesia, Arteriovenous fistula, Ultrasound
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