Background: Anaesthetic modalities for arteriovenous fistula (AVF) creation include general (GA), local (LA) and regional anaesthesia (RA). Ultrasound guided regional anaesthesia (USRA) proved to have more benefits in AVF creation than the other two. We undertook a study at the Douala General Hospital to assess these benefits over GA and RA.
Objective: We aimed to highlight the contribution of USRA in upper limb AVF creation over GA.
Method: A retrospective review was performed on 217 records of patients who underwent an AVF creation between January 2015 and January 2019.December 2018 The sociodemographic and clinical characteristics of patients were recorded and were later stratified among the anaesthetic groups. Analysis of variance, Pearson’s chi-square test and binomial logistic regression were performed and a p value of <0.05 was considered significant.
Results: Off the 217 records reviewed, age ranged between 51 and 60 years old, and 71.9% were males. The most represented age group was 51-60 years. Hypertension, Diabetes Mellitus and glomerulonephritis were the main causes of ESRD: 80.2%, 41.0% and 30.0% respectively. The American Society of Anesthesiology class II held 55.3% of the records. The distribution of AVF according to the anaesthetic type was: 83 (38.2%) for GA, and 68 (31.3%) for USRA. The most prevalent perioperative complication was the resurgence of pain (8.3%) and radiocephalic fistulae were more performed (82.5%). The length of stay with the greatest proportion was that of two days with 76.5%. The means per cost of anaesthesia were 27433.9 ± 1592.2 CFA francs for GA, and 14862.9 ± 2759.8 CFA francs for USRA. We found out that 92.6% had an immediate patency; out of these cases, 148 were matured by the sixth week and 61.3% remained functional three months after their creation. The occurrence of complications was mostly seen (9.4%) between the first week and 30 days and thrombosis was the main complication which occurred (12.9%). The rate of changeover was significantly associated with the anaesthetic type [GA: null vs. USRA: 8 (11.8%), p < 0.001]. The total anaesthesia administration time and surgical time were significantly associated with the anaesthetic type; GA: 5.8 ±1.0 min vs. USRA: 11.8 ± 3.7 min; p< 0.0001 for the total anaesthesia administration time and USRA: 101.8 ±33.2 min vs. GA: 120.1 ± 44.3 min; p=0.019 for the surgical time. The anaesthetic types were significantly associated to the AVF’s patency 3 months after to their creation and USRA held the highest rate: 56 (82.3%) in USRA vs.46 (55.4%) in GA, p < 0.004. The association between the anaesthetic type and the complication was of no statistical importance.
Conclusion: Our study showed that USRA was superior to either GA in AVF creation. The surgical duration
mitigated the time required for its performance as compared to GA. It was the most stable in term of cost of anaesthesia and yielded higher rates of functional patency 3 months after the fistulae were created. All of the above findings demonstrate the contribution of USRA in AVF creation as compared to GA.
Keywords: Brachial plexus block, arteriovenous fistula, ultrasound, cost of anaesthesia, patency