title: Pre-operative regional block anesthesia enhances operative strategy for arteriovenous fistula creation.
abstract: OBJECTIVE
  We aim to assess the effect of regional block anesthesia on vein diameter, type of AVF placement, and fistula size and flow volume.
  
  
  METHODS
  30 patients presenting for AV access procedures were followed prospectively. Vein diameters via venous ultrasound and planned location for AV access were documented. Supraclavicular brachial plexus block was followed by repeat ultrasound and alterations in operative plan were noted. Patients returned to clinic for duplex ultrasound assessment.
  
  
  RESULTS
  Average increase from baseline vein diameter with regional block was most pronounced in the lower cephalic (34%), upper cephalic (24.2%), and basilic veins (31.3%) and less in the brachial vein (8.7%). Type of AVF was modified following regional block in 14%. The rate of native AVF placement improved from 89% to 93% with regional block. Twenty-three AVF patients were available for follow-up (mean 24 weeks). Average fistula size was 7.9 mm (CI 6.9-8.9) and all patent fistulas developed flow volume >600 mL/min. Primary patency was attained in 83%. One thrombosis occurred after a basilic artery was lacerated during dialysis access. The average fistula increased 0.33 cm from post-block diameter (SD 0.22, P<.05).
  
  
  CONCLUSIONS
  Vein diameter increases significantly in the basilic and cephalic veins following regional block anesthesia and may improve the rate of native fistula placement. Propensity to dilate after regional block anesthesia does not predict size of the fistula.
authors: Division of Vascular & Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
authors: Tyler S
authors: TS
authors: Reynolds
authors: Karen M
authors: KM
authors: Kim
authors: Ramanath
authors: R
authors: Dukkipati
authors: Tien H
authors: TH
authors: Nguyen
authors: Inderjeet
authors: I
authors: Julka
authors: Clinton
authors: C
authors: Kakazu
authors: Vadim
authors: V
authors: Tokhner
authors: Joe P
authors: JP
authors: Chauvapun
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity / Q000187:drug effects; D001917:Brachial Plexus / Q000187:drug effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D002140:California; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects; D014680:Veins / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine