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超声引导下锁骨上臂丛神经阻滞作为小儿肱静脉动静脉内瘘手术中七氟醚麻醉的辅助手段:随机对照临床试验

Ultrasound-guided supraclavicular brachial plexus block as an additive to sevoflurane anesthesia in pediatrics undergoing brachiobasilic arteriovenous fistula operation: randomized controlled clinical trial.

作者信息

Elsawy Saeid, Fathy Esraa, Elbadawy Ahmed, Elnaggar Ashraf, Abdelatif Ahmed Fathy, Elmorabaa Hany, Hamed Rasha

机构信息

Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.

Anesthesia and intensive care, Faculty of Medicine, South Vally University, Qena, Egypt.

出版信息

BMC Anesthesiol. 2025 May 16;25(1):248. doi: 10.1186/s12871-025-03091-1.

Abstract

BACKGROUND

Renal disease is a significant cause of morbidity and mortality in children and is uniquely challenging in the anesthetic management of pediatric patients. Perioperative pain management is a core component in the anesthetic plan. Pediatric regional anesthesia is one of the most valuable and safe tools to treat perioperative pain.

METHODS

Sixty pediatric patients with chronic kidney disease scheduled for upper limb superficialization of brachiobasilic arteriovenous fistula to facilitate hemodialysis completed the study. Patients were randomly allocated into two groups; the block group received combined general anesthesia plus ultrasound-guided supraclavicular block, and the control group received general anesthesia only.

RESULTS

The block group recorded a significantly lower fistula maturation duration, more dilatation in basilic vein diameter, lower primary failure rate, postoperative VAS scores, anesthesia consumption, better RASS scores and longer analgesia duration. Moreover, the block group showed more stable hemodynamics with less reduction in MAP than the control group.

CONCLUSION

Ultrasound-guided supraclavicular brachial plexus block is a safe and feasible adjuvant to general anesthesia that could reduce brachiobasilic AVF maturation time, primary failure rate, control perioperative operative pain and improve the quality of anesthesia recovery by reducing emergence agitation and minimizing sevoflurane anesthesia consumption in pediatric patients with end-stage renal disease.

TRIAL REGISTRATION

The study was registered on clinical trial registration (NCT05580094) in October 2022.

摘要

背景

肾脏疾病是儿童发病和死亡的重要原因,在儿科患者的麻醉管理中具有独特的挑战性。围手术期疼痛管理是麻醉计划的核心组成部分。小儿区域麻醉是治疗围手术期疼痛最有价值和最安全的工具之一。

方法

60例计划行肱桡动静脉内瘘上肢浅表化以方便血液透析的慢性肾病患儿完成了本研究。患者被随机分为两组;阻滞组接受全身麻醉联合超声引导下锁骨上阻滞,对照组仅接受全身麻醉。

结果

阻滞组的内瘘成熟时间显著缩短,贵要静脉直径扩张更明显,初次失败率更低,术后视觉模拟评分(VAS)、麻醉药物用量更低,镇静-躁动评分(RASS)更好,镇痛持续时间更长。此外,与对照组相比,阻滞组的血流动力学更稳定,平均动脉压(MAP)下降更少。

结论

超声引导下锁骨上臂丛阻滞是全身麻醉的一种安全可行的辅助方法,可缩短肱桡动静脉内瘘成熟时间、降低初次失败率、控制围手术期疼痛,并通过减少小儿终末期肾病患者的苏醒期躁动和七氟醚麻醉用量来提高麻醉恢复质量。

试验注册

该研究于2022年10月在临床试验注册中心注册(NCT05580094)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bd4/12083093/0021f9d5be93/12871_2025_3091_Fig1_HTML.jpg

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