INFLUENCE OF TYPE OF ANESTHESIA ON HEMODYNAMIC PARAMETERS AND OUTCOME OF DIALYSIS ARTERIOVENOUS FISTULA OPERATIONS

The goal of the study was to compare effectiveness of regional and local anesthesia in dialysis arterio-venous fistula (AVF) operations. It was a prospective, randomized study. 103 patients with end stage renal disease underwent AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Duplex sonography evaluation of upper arm vessels was performed pre-operatively and at 1, 3 and 6 months postoperatively. Following parameters were measured on duplex scan: vessel diameter, blood flow rates (PSV and EDV), resistive index (RI) and pulsatility index (PI). Significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group. Time to postoperative pain initiation, need for postoperative pain killers was significantly better in Group II as compared with the Group I. Duration of operation was significantly less in regional as compared with local anesthesia. Postoperative PSV and EDVs were negatively correlated with patient age. The fistula maturation time was positively correlated with age. The vein diameter, postoperative PSV and EDV have been significantly increased in Group I as compared with Group II. The postoperative PI has significantly increased and RI has significantly decreased in Group I as compared with Group II. The total number of dialysis punctures was higher in regional as compared with the local anesthesia. Regional anesthesia provides significantly better analgesia as compared with the local anesthesia in AVF operations. It significantly improves the duplex sonography parameters after AVF formation. It can be a method of choice for some forms of fistulas.