Application of Cutaneous Nerve Block in Balloon Percutaneous Transluminal Angioplasty for Vascular Access Stenosis: A...

Percutaneous transluminal angioplasty for forearm arteriovenous fistula stenosis is frequently associated with significant pain, which may hinder patient cooperation. Ultrasound-guided cutaneous nerve blocks were evaluated as an alternative analgesic method for percutaneous transluminal angioplasty in forearm arteriovenous fistula, with the aim of reducing pain without motor paralysis or systemic complications.

This retrospective, single-center study included 77 patients who underwent percutaneous transluminal angioplasty for forearm arteriovenous fistula stenosis with ultrasound-guided cutaneous nerve block using lidocaine in October 2024. Target nerves included the lateral antebrachial cutaneous nerves, the superficial branch of the radial nerve, and/or the medial antebrachial cutaneous nerves. We retrospectively collected data on block time, percutaneous transluminal angioplasty duration, lidocaine volume, complications, presence or absence of postanesthetic motor paralysis, and analgesic efficacy. Analgesic efficacy was graded as excellent, good, or poor, with "poor" defined as pain necessitating supplemental local infiltration anesthesia for adequate relief.

The mean block preparation time was 2.1 ± 0.5 min, and the percutaneous transluminal angioplasty duration was 27.3 ± 9.2 min. The mean volume of 1% lidocaine used was 2.6 ± 1.1 mL. Minor hematomas were observed in eight cases. No patient experienced postanesthetic motor paralysis. Analgesia was rated excellent in 57.1% of patients and good in 29.9%, while poor analgesia occurred in only 12.9%. A superficial branch of the radial nerve block improved outcomes in distal forearm lesions.

Ultrasound-guided cutaneous nerve blocks provide rapid, effective, and motor-sparing analgesia for percutaneous transluminal angioplasty of forearm arteriovenous fistula stenosis, making them suitable for outpatient use and warranting further prospective evaluation.