The effects of axillary brachial plexus blocade using 0.5% ropivakaine in uremic patients

838: SUMMARYUremic patients can receive hemodialysis therapy through the AV fistula opened.Plexus brachialis block provides a better setting for surgery by ensuring vasodilation as aresult of the sympathic block it leads to, while enhancing the fistula success.In our study, we compared the quality of the axillary plexus brachialis block providedby 0.5% ropivacaine in small surgical procedures in hand, forearm and arm in patients whodid not have uremia, and in fistula surgery in those with uremia.A total of 60 randomly chosen patients who were to receive hand, forearm and armsurgeries were included in the study. The patients were in the ASA I-III risk group, and theirages varied between 18 and 65. Thirty of these patients did not have uremia (Group A),while the other 30 were uremic (Group B). Patients did not receive sedation forpremedication purposes. The patients were monitorized in the operation room, with heartbeat rates, systemic artery pressures followed at 10, 20, 30, 45, 60, 75, 90, 105, 135, and 150minutes. Venous access was placed, and 2 ml of venous blood was collected into aheparinized injector for blood gas testing. Subsequently, physiological serum was started tobe given at a rate of 2 ml/kg/hour through the venous access.Patients were placed in appropriate positions. Following sterilization of the skin andapplication of 2 ml of anesthetic, the terminal branches of the plexus brachialis, namely N.medianus, N. ulnaris, N. radialis and N. musculocutaneus in M. corocobrachialis, werestimulated one by one at the point where A. axillaris was palpated at the apex of the axilla, by5 cm long 22 G peripheral block needles, which were isolated with Teflon, except for thenerve stimulator regions and the tips. When the appropriate muscle movements were observed,0.5% ropivacaine was injected, distributed in equal quantities, into these stimulated nerves inamounts determined by formulas according to the height of the patient.Following this, the nerves in the axilla were evaluated in terms of motor and sensorialblocks one by one at 3, 6, 9, 12, 18, initiation of operation, and of operation, 120, 150, 180,210, and 240 minutes. N. medianus, N. musculocutaneus, N. radialis, and N. ulnaris wereevaluated in terms of both sensorial and motor blocks; while N. cutaneus antebrachiimedialis, N. cutaneus brachii medialis, N. transversus colli, and N. occipitalis minor wereevaluated in terms of sensorial block, and N. dorsalis scapulae in terms of motor block.Motor block was evaluated as described in the protocol, according to the function ofthe muscles innervated by each nerve, determined by the degree of related muscle movement84performed by the patient, according to the scale: 0 = the movement of the muscle related tothe studied nerve was not affected by the block at all (normal strength) 1 = the movement ofthe muscle related to the studied nerve was partially affected by the block (lower strength =paresis), 2 = the movement of the muscle related to the studied nerve was totally affected bythe block (no function at all = paralysis).Sensorial blocks were measured by pinprick test as described in the protocol as loss ofsense at the areas innervated by each nerve, with a blunt ended 27 G dental needle, andevaluated according to the scale: 0 = feels pain from the needle stick, 1 = feels sense of touchbut not pain from the needle stick (partial block = analgesia), 2= does not feel the needle stickat all (total block = anesthesia).As a result; no statistically significant difference was found in terms of sensorial andmotor blocks in all time segments in the nerves studied, between the uremic and non-uremicpatient groups.