Brachial plexus block using only 1% lidocaine to reduce pain during the endovascular treatment of dysfunctional arteriovenous access

Author:

Park Sung-Joon1ORCID,Chung Hwan Hoon1ORCID,Lee Yun Hak2,Lee Hyoung Nam3ORCID,Cho Youngjong4ORCID,Lee Sangjoon5,Lee Seung Hwa6,Yang Woo Young2

Affiliation:

1. Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea

2. Vascular and Pain Clinic, Seoul Sun Orthopedic Surgery Hospital, Seoul, Republic of Korea

3. Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea

4. Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Gangwon, Republic of Korea

5. Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju, Republic of Korea

6. Department of Radiology, Andong Hospital, Andong, Republic of Korea

Abstract

Background: Interventional endovascular treatments of dysfunctional arteriovenous (AV) access for hemodialysis can cause pain and discomfort to the patients. Ultrasound-guided brachial plexus block (BPB) is an alternative regional anesthesia method, but conventional BPB using ropivacaine or bupivacaine may cause long-lasting motor power loss, significantly reducing patient satisfaction. This study aimed to introduce BPB using only 1% lidocaine, which induces sensory loss while minimizing motor block, and evaluate the efficacy and safety of this procedure. Methods: This retrospective study was conducted on 277 consecutive patients with dysfunctional AV access requiring percutaneous transluminal angioplasty (PTA). Of these, 174 patients underwent the BPB procedure using 1% lidocaine. Time data were recorded, and the motor strength grade (MRC scale, grade 0–5) was evaluated. Numeric rating pain score (NRPS, grade 0–10) was asked during every PTA, and overall NRPS and satisfaction scores (scale 1–3) were asked after the procedure was completed. Results: Of the 174 patients who received BPB, the success rate was 100%, and there were no significant complications related to BPB. The MRC scale measured at the time when the complete sensory loss was achieved was 1.99 ± 0.63, and that at the point of sensory recovery when the block effect expired was 3.93 ± 0.62, indicating a good grade of motor strength. The average NRPS during PTA in the BPB group was significantly lower than that of the control group without BPB (1.04 ± 2.04vs 6.30 ± 2.71, p < 0.001). The overall satisfaction score was significantly higher in the BPB group than in the control group (2.79 ± 0.50vs 2.00 ± 0.81, p < 0.001). Conclusions: BPB using only 1% lidocaine can induce a sensory block while minimizing the effect on motor function. It can be applied safely in an outpatient clinic setting with relatively higher satisfaction.

Publisher

SAGE Publications

Subject

Nephrology,Surgery

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