A comparison of axillary blockage and local anesthesia techniques on autologous arteriovenous fistula flow rates and patient comfort in chronic hemodialysis patients

Abstract

Background: In this article, we aim to compare the effects of axillary nerve block and local anesthesia techniques on the flow rate and patency of arteriovenous fistulas (AVF) and postoperative early-stage pain. Methods: This prospective study included 30 patients who were scheduled for brachial artery-cephalic vein AVF construction operation between the dates June 2007 and August 2009. Group 1 (n=15) consisted of axillary nerve block, group 2 (n=15) consisted of local anesthesia administered patients. The mean age of group 1 and group 2 patients were 57.8±14.0 and 54.9±16.5 respectively. There were two patients with hypertension history in both groups. Pain scores were evaluated with visual analog scale (VAS) (0-10 cm) at 2, 6th and 24th hour after the operation. Arteriovenous fistulas patency and flow rates were measured by Doppler ultrasonography (USG) at 10th months during follow-up. Results: Postoperative pain scores of 2, 6th and 24th hour in group 1 were 1.2±0.5, 2.8±0.7 and 1.9±0.4 respectively; the same values for group 2 were 3±1.3, 3±0.7 and 2±0.5 (p=0.000; p=0.480; p=0.497). The mean flow rates measured with Doppler USG after 10 months were 966.1±206.1 ml/min in group 1 and 871.6±338.3 ml/min in group 2 (p=0.513). All the AVF were patent in group 1 and group 2. Steal syndrome arised in three patients in group 2 and none in group 1 (p=0.68). There was one patient complicated with motor blockade on the same extremity, who spontaneously recovered after 24 hours in group 1. Conclusion: We conclude that axillary blockage is an effective and safe technique in AVF construction operations which has also a positive long-term effect on AVF flow rates without any critical complication.