Stellate ganglion block for preserving arteriovenous fistula in hemodialysis patients undergoing major lower limb orthopedic surgeries: randomized control trial.

IF 2.6 3区 医学 Q2 ANESTHESIOLOGY
Ayman Mohamady Eldemrdash, Soudy S Hammad, Tarek S Hemaida, Taha Tairy Dardeer, Ahmed Adel Mohsen, Ahmed Khalaf Fathy, Gamal Hendawy Shams
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Abstract

Background: Major lower limb orthopedic surgeries can lead to hemodynamic alterations and increase the risk of arteriovenous (AV)fistula thrombosis. This study assessed the role of stellate ganglion block (SGB) in preserving the AV fistulas in hemodialysis (HD)patients undergoing major lower limb orthopedic surgeries.

Methods: In this randomized, controlled, double-blind trial, 50 chronic renal failure patients (ASA physical status III, aged 21-75 years) scheduled for major lower limb orthopedic surgeries were randomized into two groups: Group S received an ultrasound-guided SGB before spinal anesthesia, while Group C received a sham procedure. AVF function was assessed using Doppler ultrasonography on postoperative days 1 and 7. Primary outcome was AVF flow rate. Secondary outcomes included peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), thrombosis rate, and functional failure.

Results: Group S demonstrated significantly higher AVF flow rates on both postoperative day 1 (276.96 ± 49.66 ml/min vs. 217.44 ± 46.73 ml/min) and day 7 (254.96 ± 49.38 ml/min vs. 204.56 ± 47.11 ml/min), with large effect sizes (Cohen's d = 1.23 and 1.04, respectively; p < 0.001). PSV and EDV were significantly improved, and RI was significantly lower in Group S. Thrombosis (8% vs. 36%) and failure rates (32% vs. 64%) were significantly reduced compared to the control group (p < 0.05).

Conclusions: Pre-emptive stellate ganglion block was associated with significantly improved AVF flow rate postoperatively and reduced thrombosis and functional failure, suggesting its clinical benefit in maintaining AVF patency during major surgeries in HD patients.

Trial registration: This study was approved by the Ethical Committee of Aswan University Hospitals, Egypt (Institutional Review Board (IRB 900/2/24)) and registered on clinicaltrials.gov (ID: NCT06300658). The registration time of this experiment is 3/09/2024. The study protocol was designed and implemented in accordance with the CONSORT guidelines. The study protocol was conducted in compliance with the relevant guidelines and standards.

星状神经节阻滞用于保存大下肢骨科手术血液透析患者动静脉瘘:随机对照试验。
背景:重大下肢骨科手术可导致血流动力学改变,增加动静脉瘘血栓形成的风险。本研究评估了星状神经节阻滞(SGB)在血液透析(HD)患者接受重大下肢骨科手术时保留房室瘘管的作用。方法:随机、对照、双盲试验,50例慢性肾衰竭患者(ASA身体状态III,年龄21 ~ 75岁)拟行下肢重大骨科手术,随机分为两组:S组在脊髓麻醉前行超声引导下SGB, C组行假手术。术后第1、7天采用多普勒超声评估AVF功能。主要观察指标为房室血流率。次要结局包括峰值收缩速度(PSV)、舒张末期速度(EDV)、阻力指数(RI)、血栓率和功能衰竭。结果:S组术后第1天(276.96±49.66 ml/min vs. 217.44±46.73 ml/min)和第7天(254.96±49.38 ml/min vs. 204.56±47.11 ml/min) AVF血流率均显著高于对照组,且效应量较大(Cohen’S d = 1.23和1.04;p结论:先发制人的星状神经节阻滞可显著提高术后AVF血流速率,减少血栓形成和功能衰竭,提示其在HD患者大手术期间维持AVF通畅的临床益处。试验注册:该研究已获得埃及阿斯旺大学医院伦理委员会(机构审查委员会(IRB 900/2/24))的批准,并在clinicaltrials.gov上注册(ID: NCT06300658)。本实验注册时间为3/09/2024。研究方案是按照CONSORT指南设计和实施的。研究方案是按照相关指南和标准进行的。
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来源期刊
BMC Anesthesiology
BMC Anesthesiology ANESTHESIOLOGY-
CiteScore
3.50
自引率
4.50%
发文量
349
审稿时长
>12 weeks
期刊介绍: BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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