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ANALGESIA

Regional Anesthesia for Vascular Access Surgery

From the Department of Anesthesiology, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina.

Address correspondence and reprint requests to Dr. Tong J. Gan, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to tjgan{at}duke.edu.

Abstract

BACKGROUND: Approximately 25% of initial arteriovenous fistula (AVF) placements will fail as a result of thrombosis or failure to develop adequate vessel size and blood flow. Fistula maturation is impacted by patient characteristics and surgical technique, but both increased vein diameter and high fistula blood flow rates are the most important predictors of successful AVFs. Anesthetic techniques used in vascular access surgery (monitored anesthesia care, regional blocks, and general anesthesia) may affect these characteristics and fistula failure.

METHODS: We performed a literature search using key words in the PubMed/ MEDLINE database. Seven articles that related to the effects of anesthesia on AVF construction, including sympathetic block, vein dilation, blood flow, adverse outcomes, or patency rates, comprised the sources for this review.

RESULTS: Significant vasodilation after regional block administration is seen in both the cephalic and basilic veins. These vasodilatory properties may assist with AVF site selection. In the intraoperative and postoperative periods, use of a regional block, compared with other anesthetic techniques, resulted in significantly increased fistula blood flow. The greater sympathetic block contributed to vessel dilation and reduced vasospasm. Use of regional techniques in AVF construction yielded shorter maturation times, lower failure rates, and higher patency rates.

CONCLUSION: Use of regional blocks may improve the success of vascular access procedures by producing significant vasodilatation, greater fistula blood flow, sympathectomy-like effects, and decreased maturation time. However, a large-scale, prospective, clinical trial comparing the different anesthetic techniques is still needed to verify these findings.