Hemodiyaliz için arteriyovenöz fistül oluşturulmasında lokal anestezi ve bölgesel blok anestezi tekniklerinin karşılaştırılması

Year 2021, Volume: 5 Issue: 2, 154 - 160, 01.09.2021

Ufuk Turan Kürşat Korkmaz

https://doi.org/10.34084/bshr.972743

Abstract

Amaç: Kronik böbrek hastalığı olan hastalarda hemodiyaliz için arteriyovenöz fistül (AVF) oluşturulmasında lokal anestezi ve bölgesel anestezi tekniklerini karşılaştırmayı amaçladık.
Araçlar ve Yöntem: AVF oluşturulmuş toplam 90 hasta bölgesel ve lokal anestezi gruplarına ayrıldı. Fistüllerin postoperatif komplikasyonları, maturasyon süresi ve çalışma durumu kaydedildi ve iki grup arasında karşılaştırıldı. Tüm hastalar altı ay takip edildi. AVF oluşturma işlemi, sefalik venin, lokal veya bölgesel anestezi altında el bileğinin radiyal arterine şantlanmasıyla gerçekleştirildi.
Bulgular: Gruplar arasında yaş (p = 0.209) ve cinsiyet (p = 0.455) açısından anlamlı fark bulunmadı. En sık karşılaşılan postoperatif komplikasyonlar ağrı, hematom ve enfeksiyondu. Postoperatif komplikasyonlar açısından gruplar arasında anlamlı fark yoktu (tümü için p> 0.05). Fistüllerin çalışma durumu açısından gruplar arasında istatistiksel olarak anlamlı bir fark gözlenmedi (tümü için p> 0,05). Bölgesel blok anestezi uygulanan hastalarda medyan olgunlaşma süresi istatistiksel olarak anlamlı derecede daha kısaydı (p <0,001).
Sonuç: Tüm hastalar oluşturulan fistüller yoluyla başarılı bir şekilde hemodiyaliz aldı. Bölgesel blok anestezi ile fistül olgunlaşma süreleri kısaldı. Daha kısa medyan olgunlaşma süresi bölgesel anesteziyi lokal anesteziye göre daha üstün kılmaktadır. Ancak bu konuda henüz fikir birliği olmadığı için konuyla ilgili çalışmalara devam etmekte fayda görülmektedir.

Keywords

hemodiyaliz, arteriovenöz fistül, maturasyon, bölgesel anestezi, lokal anestezi

Comparison of local anesthesia and regional block anesthesia techniques in the creation of arteriovenous fistulas for hemodialysis

Abstract

Abstract
Objective: To compare local anesthesia and regional anesthesia techniques in the creation of AVFs for hemodialysis in patients with chronic kidney disease.
Methods: A total of 90 patients who underwent AVF creation were divided into regional and local anesthesia groups. Postoperative complications, maturation time and running status of the fistulas were recorded and compared between the two groups. All patients were followed-up for six months. AVF creation was performed by shunting the cephalic vein to the radial artery of the wrist under either local or regional anesthesia.
Results: No significant difference was found between the groups in terms of age (p=0.209) and gender (p=0.455). The most commonly encountered postoperative complications included pain, hematoma and infection. There was no significant difference between the groups in terms of postoperative complications (for all p>0.05). No statistically significant difference was observed between the groups in terms of the running status of the fistulas (for all p>0.05). The median maturation time was statistically significantly shorter in patients undergoing regional block anesthesia (p<0.001).
Conclusion: All patients successfully received hemodialysis through the created fistulas. Fistula maturation times were shorter with regional block anesthesia. The shorter median maturation period makes regional anesthesia superior over local anesthesia. However, since there is no consensus on this issue yet, it would be beneficial to continue studies on the subject.

Keywords

hemodialysis, arteriovenous fistula, maturation, regional anesthesia, local anesthesia

References

• Referans 1. Weyde W, Krajewska M, Klinger M. Dostęp naczyniowy do hemodializy. Forum Nefrologiczne. 2008; 1(3): 119–126.
• Referans 2. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275: 1089-92.
• Referans 3. Demir D, Tosun A, Kahraman N, et al. Technique of circular narrowıng with a polytetrafluoroethylene graft in patients with high-flow arteriovenous fistula: mid-term result. Acta Medica Mediterranea, 2017, 33: 587.
• Referans 4. Berszakiewicz A, Stanek A, Strzelczyk N, Gebala-Prajsnar K, Sieron A. Arteriovenous fistula for dialyses — what do we know today? Acta Angiol. Vol. 23, No. 3 pp. 1–8.
• Referans 5. Kim SM, Min SK, Ahn S, et al. Outcomes of Arteriovenous Fistula for Hemodialysis in Pediatric and Adolescent Patients. Vasc Specialist Int. 2016; 32(3): 113–118.
• Referans 6. Dziekiewicz M, Wierzbicki P, Prokopiuk-Wierzbicka M. Dostęp naczyniowy do hemodializ — doświadczenia własne. Pol Merk Lek. 2008; 24(142): 316–320.
• Referans 7. Lipari G, Tessitore N, Poli A, et al. Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for haemodialysis. Nephrol Dial Transplant. 2007; 22(9): 2605– –2612.
• Referans 8. Kumtepe G, Müdüroğlu A, Yüksel A, Gürbüz O. Doppler ultrasonography evaluation in hemodialysis patients prior to arteriovenous fistula surgery: Our surgical experience. Turk J Vasc Surg. 2017;26:(2)50-55.
• Referans 9. Shenoy S. Future Trends in Vascular Access Creation. Contrib Nephrol. 2017; 189: 252–256.
• Referans 10. Gao C, Weng C, He C, Xu J, Yu L. Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis. BMC Anesthesiol. 2020;20(1):219.
• Referans 11. Riella MC, Roy-Chaudhury P. Vascular access in haemodialysis: strengthening the Achilles’ heel. Nat Rev Nephro. 2013;9:348–57.
• Referans 12. Lo Monte AI, et al. Comparison between local and regional anesthesia in arteriovenous fistula creation. J Vasc Access. 2011;12:331–5.
• Referans 13. Van Zundert A, Goerig M. August Bier 1861-1949. A tribute to a great surgeon who contributed much to the development of modern anesthesia on the 50th anniversary of his death. Reg Anesth Pain Med. 2000;25(1):26-33.
• Referans 14. Cerneviciute R, Sahebally SM, Ahmed K, Murphy M, Mahmood W, Walsh SR. Regional Versus Local Anaesthesia for Haemodialysis Arteriovenous Fistula Formation: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2017;53(5):734-742.
• Referans 15. Malekpour N, Nooraei N. A Comparison of survival and quality of arteriovenous fistula between local anesthesia and axillary block methods. J Anal Res Clin Med. 2017;5(2): 45-48.
• Referans 16. Stolic R. Most important chronic complications of arteriovenous fistulas for hemodialysis. Med Princ Pract. 2013;22(3):220-228.
• Referans 17. Kazemzadeh G, Bameshki A, Fathi M, Jahanbakhsh S, Saremi E, Shoorvarzi A. Intravenous Regional Anesthesia (Bier Block) Method for Arteriovenous Fistula creation in patients with End Stage Renal Disease. Journal of Surgery and Trauma 2013; 1(1): 11-5.
• Referans 18. Sahin L, Gul R, Mizrak A, et al. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas. J Vasc Surg. 2011;54(3):749-753.
• Referans 19. Aitken E, et al. Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial. Lancet. 2016; 388(10049):1067 –74.
• Referans 20. Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M, Jr., et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002;35(3):603-10.
• Referans 21. Zaliunaite R, Kearns R, Clancy M, MacFarlane A. Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation? Proceedings of the 30th Annual European Society of Regional Anaesthesia (ESRA) Congress; 2011 Sep 7-10; Dresden, Germany.
• Referans 22. Jodko DM, Obidowski DS, Reorowicz P, JÓŹwik K. A two-stage model of an arteriovenous fistula maturation process. Acta Bioeng Biomech. 2020;22(2):139-153.
• Referans 23. Huijbregts HJ, Bots ML, Moll FL, Blankestijn PJ; CIMINO members. Hospital specific aspects predominantly determine primary failure of hemodialysis arteriovenous fistulas. J Vasc Surg. 2007;45(5):962-967.
• Referans 24. Dixon BS. Why don't fistulas mature?. Kidney Int. 2006;70(8):1413-1422.
• Referans 25. Yildirim V, Doganci S, Yanarates O, et al. Does preemptive stellate ganglion blockage increase the patency of radiocephalic arteriovenous fistula?. Scand Cardiovasc J. 2006;40(6):380-384.