Comparison between local and regional anesthesia in arteriovenous fistula creation

• Published in: The journal of vascular access Vol. 12; no. 4; pp. 331 - 335
• Main Authors: Lo Monte, Attilio Ignazio, Damiano, Giuseppe, Mularo, Antonino, Palumbo, Vincenzo Davide, Alessi, Rosi, Gioviale, Maria Concetta, Spinelli, Gabriele, Buscemi, Giuseppe
• Format: Journal Article
• Language: English
• Published: United States 01-10-2011
• Subjects: Aged; Amides - administration & dosage; Anesthesia, Local - adverse effects; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Arteriovenous Shunt, Surgical - adverse effects; Brachial Plexus - drug effects; Female; Forearm - blood supply; Forearm - innervation; Humans; Italy; Kidney Failure, Chronic - therapy; Lidocaine - administration & dosage; Male; Middle Aged; Nerve Block - adverse effects; Radial Artery - surgery; Renal Dialysis; Time Factors; Treatment Outcome; Ultrasonography, Doppler; Vasodilation - drug effects; Veins - diagnostic imaging; Veins - drug effects; Veins - surgery
• DOI: 10.5301/JVA.2011.8560
• EISSN: 1724-6032
• ISSN: 1129-7298

Assessment of the effectiveness of brachial plexus block (BPB) via axillary approach compared to regional anesthesia for arteriovenous fistula surgery in patients affected by end-stage renal disease.
We compared forty patients randomly divided into two groups. Group A underwent BPB procedure with 15 mL ropivacaine 1% and 10 mL of saline (0.9% NaCl) via axillary approach. Group B received local anesthesia with lidocaine 2%. The forearm blood vessels were assessed by Doppler ultrasonography before and after the intervention.
BPB performed on Group A was associated with a considerable venous dilation and a significant decrease (48.7%, P<.05) in pulsatility index (PI) measured by Doppler ultrasound. In Group B, PI and venous dilation remained unaltered in the postoperative phase. No complications such as thrombosis or occlusion were encountered among patients who underwent BPB.
The axillary-approached BPB was more advantageous than local anesthesia. Its effectiveness was because of venous dilation and the decrease in the PI, consequent to the reduction in peripheral resistances and the increase in local blood flow, thus offering an ideal background for fistula creation and short-term patency.