Anest. intenziv. Med. 2023;34(2):46-50 | DOI: 10.36290/aim.2023.031

The use of brachial plexus blockade in the formation of arteriovenous fistulas. Comparison with local infiltration anesthesia and general anesthesiaOriginal Article

Koyš R.¹, Drobná Sániová B.¹, Čiljaková Z.¹, Šinák I.², Drobná E.³

¹ Klinika anestéziológie a intenzívnej medicíny, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin

² Oddelenie cievnej chirurgie, Univerzitná nemocnica Martin

³ Katedra informatiky, Akadémia ozbrojených síl generála M. R. Štefánika, Liptovský Mikuláš

Objective: To determine the advantages of supraclavicular blockade of the brachial plexus in the formation of arteriovenous fistulas for hemodialysis treatment. Comparison of peripheral nerve block, general and local infiltration anesthesia in the formation of fistulas.

Design: Prospective non-randomized study. Approved by the ethics committee of JLF UK in Martin. Setting: University hospital.

Material and methods: Three groups of patients who were created arteriovenous fistula. A group of 20 patients were operated under peripheral nerve block anesthesia, 20 patients were operated under local infiltration anesthesia and 5 patients were operated under general anesthesia. The main monitored parameter was the preserved function of the fistula 24 hours and 6 weeks after the operation. Inclusion criteria: age 19-75 years, ASA 3-4, weight 40-120 kg, BMI up to 40. Statistical methods: Mann-Whitney U test and exact two-tailed test, Shapiro-Wilk test, Fisher's two-tailed exact test, paired Wilcoxon's exact two-tailed test.

Results: After 24 hours, all fistulas created under peripheral nerve block anesthesia were functional, 90 % under local infiltration anesthesia and 80 % under general anesthesia. There was no statistically significant dependence between the functionality of the fistula and any type of anesthesia. After 6 weeks, 80 % of fistulas created under general or peripheral nerve block anesthesia and only 50 % of fistulas under local infiltration anesthesia were functional. For peripheral nerve block anesthesia and local infiltration anesthesia, a statistically significant difference was found in favor of peripheral nerve block anesthesia (p < 0.05).

Conclusion: Peripheral nerve block anesthesia was associated with better fistula survival compared to local infiltration anesthesia in our study. General anesthesia had fistula survival comparable to peripheral nerve block anesthesia, but was associated with a higher incidence of complications.

Keywords: brachial plexus block, general anesthesia, local infiltration anesthesia, peripheral nerve block, arteriovenous fistula.

Received: March 29, 2023; Revised: June 19, 2023; Accepted: July 3, 2023; Published: July 21, 2023  Show citation