Regional anaesthesia practice for arteriovenous fistula formation surgery

Abstract

Summary We conducted a survey and semi‐structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thirty‐five centres reported routine use of brachial plexus blocks, but variation in anaesthetic skill‐mix and practice were observed. Interviews were conducted with 19 clinicians from 10 NHS Trusts including anaesthetists, vascular access and renal nurses, surgeons and nephrologists. Thematic analysis identified five key findings: (1) current anaesthetic practice showed that centres could be classified as ‘regional anaesthesia dominant’ or ‘local anaesthesia/mixed’; (2) decision making around mode of anaesthesia highlighted the key role of surgeons as frontline decision makers across both centre types; (3) perceived barriers and facilitators of regional block use included clinicians’ beliefs and preferences, resource considerations and patients’ treatment preferences; (4) anaesthetists’ preference for supraclavicular blocks emerged, alongside acknowledgement of varied practice; (5) there was widespread support for a future randomised controlled trial, although clinician equipoise issues and logistical/resource‐related concerns were viewed as potential challenges. The use of regional anaesthesia for arteriovenous fistula formation in the UK is varied and influenced by a multitude of factors. Despite the availability of anaesthetists capable of performing regional blocks, there are other limiting factors that influence the routine use of this technique. The study also highlighted the perceived need for a large multicentre, randomised controlled trial to provide an evidence base to inform current practice.

Could anaesthetic technique be blocking successful outcomes in arteriovenous fistula surgery?

“…Most AVF in the UK are currently created under either LA or RA. 20 Several non-randomised 21,22 and subsequent small randomised studies suggested better early patency rates for AVF created under RA. 23e25 Our (AJRM, EA) single-centre randomised controlled trial (n¼126) remains the largest to date and showed better early to medium term (3 months) patency rates for AVF created under a single-shot brachial plexus block compared to LA (84% vs 62%; odds ratio [OR] 3.3 [95% CI 1.4 to 7.6] p¼0.005).…”

The importance of anesthesiological methods in the creation of arteriovenous fistulas

“…Decisions about the mode of anesthesia depend on a number of interrelated factors, including expertise, inclination, habit, practicality, and norms. 14…”

Effects of double vs triple injection on block dynamics for ultrasound-guided intertruncal approach to the supraclavicular brachial plexus block in patients undergoing upper limb arteriovenous access surgery: study protocol for a double-blinded, randomized controlled trial

“…Supraclavicular block is the most common and preferred anesthesia method for arteriovenous (AV) fistula formation surgery [ 1 ]. Since nerve blocks tend to increase vasodilation, blood flow, and tissue oxygenation during autogenous AV fistula creation, they improve the successful rate of fistula [ 2 ].…”