Effect of Different Methods of Anesthesia on Surgically Created Arteriovenous Fistula

Abstract

Aim of the study was to determine the advantages of peripheral nerve blocks  (PNB) versus local infiltration anesthesia (LIA) in the formation of arteriovenous fistula (AVF) surgically created for hemodialysis treatment Type of study: prospective non-randomized study. Approved by the ethics committee of JLF UK in Martin.Type of workplace: clinical workplace of a university hospital.  Material and method. The cohort of patients (n=40) who required arteriovenous fistula (AVF) creation was divided into 2 groups, 20 patients each:  patients operated under peripheral nerve blockade and patients operated under local infiltration anesthesia. The preserved function of the fistula was monitored 24 hours, 6 weeks and one year after the operation, without revision. Patient inclusion criteria included: age 19-75 years, ASA 3-4, weight 40-120kg, BMI up to 40. Statistical treatment of data included Mann-Whitney exact test, Fisher's test, t-test, ShapiroWilk normality test.  Results. After 24 hours, all fistulas created with peripheral nerve blockade were functional whereas only 90% developed under local infiltration anesthesia remained functional (P>0.05 between groups). However, after 6 weeks, 80% of fistulas created under peripheral nerve block were functional, compared to 50% of functional  fistulas created in patients under local infiltration anesthesia. (p=0.048). One year after surgery, the difference became a trend since 55% of fistulas created in peripheral nerve block remained functional while only 35% of fistulas created in patients receiving local infiltration anesthesia were functional without complications (p=0.097). Conclusion. In our study, the peripheral nerve block anestesia seem superior in term of better created  fistula survival compared to local infiltration anesthesia.