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David Shemesh1, Yefim Raikhinstein, Dina Orkin

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Brachial plexus block anesthesia offers a safer alternative to general anesthesia for arteriovenous access creation in patients with end-stage renal disease. This regional anesthesia technique improves surgical outcomes by minimizing vessel damage and preventing vasospasm.

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Area of Science:

  • Vascular Surgery
  • Anesthesiology
  • Nephrology

Background:

  • Arteriovenous access construction is crucial for hemodialysis in end-stage renal disease (ESRD) patients.
  • Anesthesia choice significantly impacts surgical decision-making and patient outcomes in this fragile population.
  • Complications associated with anesthesia can exacerbate risks in ESRD patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of different anesthesia types for arteriovenous access construction.
  • To highlight the advantages of brachial plexus block over general and local anesthesia in ESRD patients.
  • To explore the potential benefits of regional anesthesia in improving fistula patency and surgical outcomes.

Main Methods:

  • Comparative discussion of anesthesia techniques, focusing on brachial plexus block.
  • Analysis of anesthetic effects on blood vessels during microsurgical anastomosis.
  • Review of postoperative effects, including vasodilation and blood flow enhancement.

Main Results:

  • Brachial plexus block is identified as a potentially safer alternative to general anesthesia for ESRD patients.
  • Brachial plexus block offers advantages over local anesthesia, including enabling tourniquet use and preventing vasospasm.
  • Regional anesthesia's sympathectomy-like effect promotes vasodilation, potentially reducing early fistula thrombosis.

Conclusions:

  • Brachial plexus block is a superior anesthetic choice for arteriovenous access creation in ESRD patients.
  • Regional anesthesia can mitigate risks associated with vascular damage and vasospasm, improving surgical outcomes.
  • The vasodilatory effects of regional anesthesia may enhance fistula function and long-term patency.