Observational study of the efficacy of supraclavicular brachial plexus block for arteriovenous fistula creation.

BACKGROUND AND AIMS: Arteriovenous (AV) fistula surgery is commonly performed for AV access for hemodialysis. However the ideal anaesthetic technique of choice remains debated. We aimed to assess operative conditions, vascular patency, and complication rate following AV fistula surgery with isolated brachial plexus block among end-stage renal disease (ESRD) patients.

METHODS

This prospective, observational study included 214 patients undergoing AV fistula surgery under isolated supraclavicular brachial plexus block between January and December 2017. The diameters of the vessels both before and after the block, and the patency of the AV fistula in the immediate postoperative period and after 3 months were assessed using ultrasound Doppler. The change in the vessel diameter both before and after block was compared using independent sample t-test.

RESULTS

The mean brachial artery diameter increased by 0.09 mm (P = 0.002), and cephalic vein diameter at elbow, radial artery, and cephalic vein at wrist diameters increased by 0.5 mm (P < 0.001), 0.08 mm (P = 0.031), and 0.48 mm (P < 0.001), respectively. Overall, 93.45% had immediate patency, 85.51% had primary, and 47.19% had functional patency at 3 months. In the brachiocephalic group, 96.24% had immediate patency, 87.21% had primary, and 27.06% had functional patency at 3 months. Among the radiocephalic group, 91.35% had immediate patency, 82.71% had primary patency, and 71.60% had functional patency at 3 months.

CONCLUSION

Ultrasound-guided isolated brachial plexus block results in good vasodilation and achieves good immediate and long-term patency in AV fistula surgery.