OBJECTIVE: Brachial plexus block offers several advantages when creating vascular access for hemodialysis. However, no controlled studies have directly evaluated arteriovenous fistula (AVF) blood flow in patients anesthetized by this method. We compared the effects of ultrasound-guided, infraclavicular brachial plexus block and local infiltration anesthesia on blood flow in the radial artery and AVF during the early and late postoperative periods. METHODS:Sixty patients were randomly assigned to an experimental group, which received infraclavicular brachial plexus block (IB), or to a control (C) group that received local infiltration anesthesia. Blood flow in the distal radial artery was measured before and after IB or infiltration anesthesia. AVF flow during the early and late postoperative period was evaluated using duplex ultrasound imaging. The rates of primary fistula failure were also compared. RESULTS: After anesthesia, preoperative radial arterial flow was 56 ± 8.6 mL/min in group IB vs 40.7 ± 6.11 mL/min in group C (P < .0001). Blood flow in the fistula, measured in mL/min at 3 hours, 7 days, and 8 weeks postoperatively, was also greater in group 1B vs group C, respectively, at 69.6 ± 7.9 vs 44.8 ± 13.8 (P < .001), 210.6 ± 30.9 vs 129 ± 36.1 (P < .001), and 680.6 ± 96.7 vs 405.3 ± 76.2 (P < 0.001). CONCLUSION: When used for AVF access surgery, infraclavicular brachial plexus block provides higher blood flow in the radial artery and AVF than is achieved with infiltration anesthesia.
RCT Entities:
OBJECTIVE: Brachial plexus block offers several advantages when creating vascular access for hemodialysis. However, no controlled studies have directly evaluated arteriovenous fistula (AVF) blood flow in patients anesthetized by this method. We compared the effects of ultrasound-guided, infraclavicular brachial plexus block and local infiltration anesthesia on blood flow in the radial artery and AVF during the early and late postoperative periods. METHODS: Sixty patients were randomly assigned to an experimental group, which received infraclavicular brachial plexus block (IB), or to a control (C) group that received local infiltration anesthesia. Blood flow in the distal radial artery was measured before and after IB or infiltration anesthesia. AVF flow during the early and late postoperative period was evaluated using duplex ultrasound imaging. The rates of primary fistula failure were also compared. RESULTS: After anesthesia, preoperative radial arterial flow was 56 ± 8.6 mL/min in group IB vs 40.7 ± 6.11 mL/min in group C (P < .0001). Blood flow in the fistula, measured in mL/min at 3 hours, 7 days, and 8 weeks postoperatively, was also greater in group 1B vs group C, respectively, at 69.6 ± 7.9 vs 44.8 ± 13.8 (P < .001), 210.6 ± 30.9 vs 129 ± 36.1 (P < .001), and 680.6 ± 96.7 vs 405.3 ± 76.2 (P < 0.001). CONCLUSION: When used for AVF access surgery, infraclavicular brachial plexus block provides higher blood flow in the radial artery and AVF than is achieved with infiltration anesthesia.
Authors: Emma Aitken; Rachel Kearns; Lucian Gaianu; Andrew Jackson; Mark Steven; John Kinsella; Marc Clancy; Alan Macfarlane Journal: J Am Soc Nephrol Date: 2020-07-24 Impact factor: 10.121
Authors: Alan James Robert Macfarlane; Rachel Joyce Kearns; Emma Aitken; John Kinsella; Marc James Clancy Journal: Trials Date: 2013-08-19 Impact factor: 2.279
Authors: Jennifer M MacRae; Matthew Oliver; Edward Clark; Christine Dipchand; Swapnil Hiremath; Joanne Kappel; Mercedeh Kiaii; Charmaine Lok; Rick Luscombe; Lisa M Miller; Louise Moist Journal: Can J Kidney Health Dis Date: 2016-09-27
Authors: Jennifer M MacRae; Christine Dipchand; Matthew Oliver; Louise Moist; Charmaine Lok; Edward Clark; Swapnil Hiremath; Joanne Kappel; Mercedeh Kiaii; Rick Luscombe; Lisa M Miller Journal: Can J Kidney Health Dis Date: 2016-09-27
Authors: Selvakumar Palaniappan; Venkatesh Subbiah; V Raja Gopalan; Poornima Vijaya Kumar; R John Santa Vinothan Journal: Indian J Anaesth Date: 2018-08