Single center, retrospective review.
Regional anesthesia is associated with improved distal access configuration with acceptable patency rates when compared with local anesthesia.
The use of regional anesthesia allows for improved likelihood of achieving the most distal access possible based on preoperative ultrasound testing and could potentially change from a planned arterial-venous graft to an autogenous creation.
Purpose: 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.
Methods: This is a single institution, retrospective review of 1 surgeon's case volume over the course of January 2015 to December 2016. Patients' charts were reviewed and selected based on dialysis access with regional anesthesia and adequate intraoperative/postoperative information to warrant inclusion. Other modalities for anesthesia were included. Primary outcomes included: functional patency at 6 months, whether the most distal access was obtained at the time of the operation based on preoperative planning, and whether there was a change in operative plans based on preoperative imaging.
Results: Overall, 164 charts were reviewed, with 45 patients included in this study. Thirty-three patients had regional anesthesia, 10 had local, and 2 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 preoperative assessment (P = 0.03). There was no clear advantage in terms of functional patency at 6 months. When comparing the changes in planned access based on the use of intraoperative ultrasound, there was a moderately acceptable effect on functional patency (P = 0.08).
Conclusion: Regional anesthesia 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, develop the most distal configuration possible. However, given the small sample size and single institution evaluation, these conclusions are incomplete until further prospective studies can be conducted.