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Regional vs local anesthetic technique in surgical fistula success rate among patients requiring dialysis
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Regional anesthetic technique increased the success of surgery even one year after the procedure, according to a study comparing regional anesthetic and local anesthetic technique at the time of surgery.
In the study – published in The Lancet – investigators examined patients who received a surgically created fistula to enable dialysis for end-stage kidney disease.
“This is one of the first randomized studies to show a benefit on surgical outcome lasting up to one year related solely to the anesthetic,” Alan J.R. Macfarlane, MD, of Glasgow Royal Infirmary in Scotland, said in a related press release. “Our findings have the potential to deliver significant patient (and hospital cost) benefits worldwide by reducing the number of redo fistula operations through using regional anesthesia.”
Macfarlane explained that although the patients remain awake with both techniques, the regional anesthetic technique, which involves using an ultrasound-guided injection, numbs the whole arm, whereas local anesthetics freezes the small surgical sight. Macfarlane also noted in the press release that the regional technique increases the sizes and improves blood flow through vessels during and several hours after the operation. This makes surgery easier and reduces early blood clothing, and subsequent failure, of the fistula.
Macfarlane and colleagues originally reported that more fistulas were working at three months after the operation because of the regional anesthetic technique. They are now reporting on data after one year, continuing to support use of the technique.
He presented the findings at the World Congress on Regional Anesthesia and Pain Medicine on Saturday, April 21.