Tumescent anesthesia reduces pain associated with balloon angioplasty of hemodialysis fistulas

Abstract

We describe the use of tumescent local anesthesia during endovascular treatment of arteriovenous fistula stenosis. Using ultrasound guidance, 11 patients were hand-injected with tumescent lidocaine anesthesia around the fistula stenosis prior to endovascular therapy. All patients rated the pain experienced during angioplasty on a numeric scale (0-10). The mean balloon inflation pressure was 12 ± 3.01 atm. During angioplasty, eight patients reported pain between 0 and 2; three patients reported 4, 5, and 7 out of 10 on the pain scale. In this small series, tumescent anesthesia provided adequate pain control to perform angioplasty of arteriovenous fistulas.

Estimated Maximal Safe Dosages of Tumescent Lidocaine

“…The mean Tmax without liposuction was 13.1 hours (range, 8-24), which was not significantly different from the mean Tmax with liposuction 12.5 hours (range, [8][9][10][11][12][13][14][15][16][17][18]; P = 0.19).…”

What the phlebologist should know about local anesthetics

“…32,33 Also in other peripheral vascular and endovascular interventions, the usefulness of tumescent local anesthesia is explored. 35 Lidocaine still is the most popular local anesthetic agent used for tumescent anesthesia. The concentration used for tumescent anesthesia ranges between 0.05 and 1.5%, though higher concentrations may be needed for surgery of more sensitive body areas.…”

Cultural and psychological determinants of pain assessment during lower limb angioplasty

“…Pain experienced by patients during peripheral angioplasty has not often been a subject of clinical analyses. Additionally, most publications are based on early reports regarding coronary angioplasty and dialysis access and early endovascular procedures performed on peripheral vessels [1,4,5].…”

“…The underlying causes of the differences are both cultural factors (including the nationality) that affect the way people meet their health needs and psychological factors in the form of personal resources determining the behaviours connected with health and disease. A combination of those factors models individual ideas and stereotypes regarding health and disease, the way of experiencing and interpreting causes and symptoms of disease, attitudes to disease, pain, medical staff, patient's role, treatment procedures, prophylaxis and lifestyle [1][2][3][4][5]. The way of experiencing, expressing and controlling pain is one of the behaviours learned in the course of gaining individual experience and socialisation, depending on the kind of social environment, and therefore nationality.…”