Looking for the Benefit of Regional Anestheisa in Dialysis Access Surgery
Sean Malarkey, DO.
Allegheny Health Network, Pittsburgh, PA, USA.
Objective: The purpose of this paper was to evaluate our institutional experience with regional anesthetic and whether this is a modality worth continuing to pursue given its associated risks. Previous research has evaluated the efficacy of regional anesthesia and the possible improvement in 3 month patency rates. However, current research has not directly assessed the ability to transition from an anticipated access placement to a more desirable access such as avoiding a graft or achieving the most distal configuration possible. Anecdotally, we had observed this transition based on intra-operative ultrasound assessment post-block compared to pre-operative mapping and planning.
Methods: This is a single institution, retrospective review of one surgeon’s case volume over the course of January 2015 to December 2016. Patient’s charts were reviewed and selected based on dialysis access with regional anesthesia and adequate intra-operative/post-operative information to warrant inclusion. Other modalities for anesthesia were included. Primary outcomes included: functional patency at six months, whether the most distal access was obtained at the time of the operation based on pre-operative planning, and whether there was a change in operative plans based on pre-operative imaging.
Results: Overall, 164 charts were reviewed, with 45 patients included in this study. Thirty-three patients had regional anesthesia, ten had local, and two underwent general anesthesia. The results showed that in comparing regional and local anesthesia, there was a clear statistical benefit in achieving the most distal configuration based on planned pre-operative assessment (p=0.0279). There was no clear advantage in terms of functional patency at six months. When comparing the changes in planned access based on the use of intra-operative ultrasound, there was a moderately acceptable effect on functional patency (p=0.08).
Conclusion: There is no clear advantage to regional anesthesia. However, it does appear to have certain early technical benefits due to venodilatation. It may also lend the surgeon to develop more autogenous fistulas on the day of the operation avoiding graft placement, or at minimum, construct the most distal configuration possible.
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