Ultrasound-guided supraclavicular brachial plexus anaesthesia improves arteriovenous fistula flow characteristics in end-stage renal disease patients

Abstract

Background: Surgical construction of an arteriovenous fistula is preferred for end-stage renal failure patients requiring long-term haemodialysis. Methods: Patients were randomised into two groups: brachial plexus group (n = 30) or local infiltration group (n = 30). In all patients, a radiocephalic arteriovenous fistula was created by an experienced surgeon using a standard surgical technique. In both groups 20 ml of 0.375% ropivacaine was used. Doppler assessment of vessels was performed at fixed time intervals. Results: Primary patency rate was 100% in the brachial plexus block group whereas there was 10% fistula failure rate in the local infiltration group (p-value = 0.237). Diameter of the vessels, peak systolic velocity, mean diastolic velocity, and blood flow at 30 minutes, 48 hours, 2 weeks, and 6 weeks after the fistula creation was significantly greater than the preoperative diameter in all patients (p-value < 0.05). Intergroup comparison revealed that vascular parameters were significantly better in the brachial plexus analgesia group versus local infiltration group at all observation points up to and including six weeks post fistula creation (p-value < 0.05). Conclusion: Brachial plexus anaesthesia significantly dilates the vessel diameter and increases blood flow whereas local infiltration has a negligible effect on vessel diameter and blood flow.

Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis

“…Moreover, time to postoperative pain initiation was significantly higher in the RA versus LA group. Thus, we conclude that RA provides better pain control intra-as well as post-operatively in dialysis AVF operations, enabling patients to feel more comfortable [6].…”

“…Adequate pain control is extremely important in patients with end-stage renal disease with severe co-morbidities [21]. The prospective, randomized, clinical study from Shoshiashvili et al [6] showed significantly different results between BPB and LA groups in terms of pain intensity. The need for intra-as well as post-operative pain killers was significantly less in the BPB versus LA group (p = 0.0363 and p = 0.0318, respectively).…”

“…In total, 7 studies, including 852 patients [3,4,[6][7][8][9][10], evaluated primary patency rates in RA versus LA; RA was associated with higher primary patency rates than LA (OR, 1.88; 95% CI, 1.24-2.84; P = 0.003; I 2 , 31%; Fig. 3).…”

Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis

“…In total, 7 studies, including 852 patients, [ 2 , 3 , 5 – 9 ] evaluated primary patency rates in RA versus LA; RA was associated with higher primary patency rates than LA (OR, 1.88; 95% CI: 1.24–2.84; P = 0.003; I 2 = 31%; Fig. 3 ).…”

Long-Term Functional Patency and Cost-Effectiveness of Arteriovenous Fistula Creation under Regional Anesthesia: a Randomized Controlled Trial

“…Due to the relatively small sample size, cost-effectiveness analysis was not performed for Three smaller randomised trials all demonstrated the beneficial effects of RA in short-term AVF maturation although these have been considered to have a high level of bias with outcomes often limited to surrogate data. 27,28,29 Two recent meta-analyses also favoured RA 14,30 but no trial to date has studied the long-term effects of RA. Nevertheless the recent European Vascular Access and European Renal Best Practice guidelines recommend the use of RA for AVF creation 1,31 .…”