Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial

Aitken, Emma; Jackson, Andrew; Kearns, Rachel; Steven, M.; Kinsella, John; Clancy, Marc; Macfarlane, Alan

doi:10.1016/s0140-6736(16)30948-5

Cited by 100 publications

(110 citation statements)

References 39 publications

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“…Immediate patency was higher with regional anaesthesia (93% vs. 73%), as was functional patency at 3 months in RCAVFs (73% vs. 40%). 67 A recent meta-analysis confirmed sympathetic blockade with regional brachial plexus block of sustained benefit in patients undergoing AVF formation. 68…”

Section: Operative Surgical and Endovascular Methods To Improve Avf Mmentioning

confidence: 93%

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Tordoir

Zonnebeld

Loon

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Operative Surgical and Endovascular Methods To Improve Avf Mmentioning

confidence: 93%

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Tordoir

Zonnebeld

Loon

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…In arteriovenous-fistula-formation surgery, RA compared to local anaesthesia has been shown to have a long-lasting benefit, with patency of arteriovenous fistulae at 3 months significantly higher in the RA group compared to those fistulas created under local anaesthesia. 19 Early failure is reduced in the RA group possibly due to a reduction in thrombosis secondary to the RA-mediated sympathetic block, which increases fistula blood flow and reduces vasospasm. This early benefit persists, representing one of the only randomized studies to demonstrate a long-lasting surgical outcome benefit directly linked to RA.…”

Section: Vascular Surgerymentioning

confidence: 96%

Regional anaesthesia and outcomes

2018

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Regional anaesthesia (RA) reduces acute pain, chronic pain after some surgical procedures, postoperative nausea and vomiting, and pulmonary complications. RA can reduce length of stay and improve operating department throughput. Although RA confers short-term functional benefits, these are generally not sustained. Combined general anaesthesia and epidural analgesia may increase the incidence of adverse cardiac events. Some studies have shown RA to be associated with a reduction in cancer recurrence, bloodtransfusion requirements, surgical site infections, ICU admission, and mortality; however, these associations must be treated cautiously.

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“…Our survey demonstrated significant variation in the preferred approach for brachial plexus block. Although a previous RCT used mainly supraclavicular blocks as the intervention, the results from this survey show that the majority of cases are performed using other techniques, such as axillary, with notable variation in the blocks used across centres. Furthermore, five centres confirmed they already consider brachial plexus blocks superior, whereas 14 out of 39 centres perform brachial plexus blocks for < 10% of AV fistula formation surgery.…”

Section: Discussionmentioning

confidence: 87%

Regional anaesthesia practice for arteriovenous fistula formation surgery

et al. 2020

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Summary We conducted a survey and semi‐structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thirty‐five centres reported routine use of brachial plexus blocks, but variation in anaesthetic skill‐mix and practice were observed. Interviews were conducted with 19 clinicians from 10 NHS Trusts including anaesthetists, vascular access and renal nurses, surgeons and nephrologists. Thematic analysis identified five key findings: (1) current anaesthetic practice showed that centres could be classified as ‘regional anaesthesia dominant’ or ‘local anaesthesia/mixed’; (2) decision making around mode of anaesthesia highlighted the key role of surgeons as frontline decision makers across both centre types; (3) perceived barriers and facilitators of regional block use included clinicians’ beliefs and preferences, resource considerations and patients’ treatment preferences; (4) anaesthetists’ preference for supraclavicular blocks emerged, alongside acknowledgement of varied practice; (5) there was widespread support for a future randomised controlled trial, although clinician equipoise issues and logistical/resource‐related concerns were viewed as potential challenges. The use of regional anaesthesia for arteriovenous fistula formation in the UK is varied and influenced by a multitude of factors. Despite the availability of anaesthetists capable of performing regional blocks, there are other limiting factors that influence the routine use of this technique. The study also highlighted the perceived need for a large multicentre, randomised controlled trial to provide an evidence base to inform current practice.

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Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial

Cited by 100 publications

References 39 publications

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Regional anaesthesia and outcomes

Regional anaesthesia practice for arteriovenous fistula formation surgery

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