Combined interscalene and supraclavicular brachial plexus block using ultrasound guidance versus general anaesthesia for brachioaxillary graft in patients with chronic renal failure

Background: Anaesthesia for patients with chronic renal failure (CRF) is a challenge. We compared combined interscalene (ISB) and supraclavicular (SCB) block using ultrasound guidance versus general anesthesia in patients with CRF undergoing brachioaxillay graft surgery. Methods: This randomized open label blind end-point pilot study was conducted in a university-affiliated hospital, Egypt from January 2018 to July 2019. We enrolled 60 patients with CRF undergoing brachioaxillary graft surgery. GA group (n=30) received general anaesthesia while RA group (n=30) received combined ISB and SCB. We evaluated numerical rating scale (NRS), surgeon and patient satisfaction, onset and duration of motor and sensory block, duration of surgery and complications. Results: NRS statistically decreased in RA group. The first need of analgesia significantly delayed and the number of times analgesics were required was less in RA group. Surgeon and patient satisfaction were similar in both groups. The onset of  sensory block  was 4.37 minutes and lasted for 9.5 hours while the onset of motor block was 6.73 minutes and lasted for 6 hours. No complications were detected in both groups.   Conclusion: Combined ISB and SCB technique is an excellent alternative to general anaesthesia in patients with CRF undergoing brachioaxillary graft. It implies better surgeon and patient satisfaction with lower NRS and number of analgesia requirements with delayed first need of analgesia.