A Comparison of survival and quality of arteriovenous fistula between local anesthesia and axillary block methods

Nasser Malekpour,Navid Nooraei

doi:10.15171/jarcm.2017.009

Abstract

Introduction: Vascular access for dialysis is considered the biggest challenge for chronic dialysis patients, and arteriovenous fistula (AVF) is still the best way to provide vascular access for dialysis. In the present study, survival and quality of AVF was compared between local anesthesia and regional block techniques. Methods: The present study recruited patients with end-stage renal disease (ESRD) undergoing hemodialysis through AVF in 2014-2015. The subjects were randomly divided into local anesthesia (A) and axillary block (B) groups, and received AVF in the antecubital region. The AVF patency and flow were compared between the two groups both long-term and short-term. Data was analyzed in SPSS software. Results: In the present study, 60 patients with ESRD and candidates for AVF creation were divided into local anesthesia (A) and axillary block (B) groups of 30 people. Patients' mean age was 54.28 [standard deviation (SD) = 14.45] years. No significant difference was observed between the two groups in mean AVF flow and patency 24 hours, 10 days, and 6 months after the surgery. Gender had no effect on AVF flow in the two groups. However, AVF flow was significantly lower in patients with diabetes and ischemic heart disease (IHD). Conclusion: The results obtained showed no significant difference in AVF flow and patency between local anesthesia and axillary block both in the short-term and long-term. Diabetes and IHD significantly reduced AVF flow.

Highlights

In the present study, 60 patients with end-stage renal disease (ESRD) and candidates for arteriovenous fistula (AVF) creation were divided into local anesthesia (A) and axillary block (B) groups of 30 people
The results obtained showed no significant difference in AVF flow and patency between local anesthesia and axillary block both in the short-term and long-term
Considering the poor health conditions of patients with end-stage renal disease (ESRD), an alternative method to general anesthesia should be used for AVF

Summary

Arteriovenous fistula and anesthesia

Lo Monte et al compared local anesthesia with lidocaine and regional block with bupivacaine, and observed significant venous dilatation and reduction in pulsatility index (PI) in the regional block group compared to the local anesthesia group.[3]. Local anesthesia and regional block techniques were compared in terms of AVF flow and patency. A sample size of 30 in each group was sufficient to detect a clinically important difference of 70 points (between the intervention and control groups) on the AVF flow 6 months after the surgery, assuming a standard deviation (SD) of 100 and 94 points for intervention and control groups, respectively, using a two-tailed t-test of the difference between means, a power of 80%, and a significance level of 5%. Patients were randomly divided into local anesthesia group (A) [receiving lidocaine 2% (3 cc to 5 cc)], and axillary regional block (B) [receiving lidocaine 1.5% (20 cc to 30 cc)]. Both groups underwent AVF creation in the antecubital region.

Malekpour and Nooraei

Findings

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