title: Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure.
abstract: BACKGROUND
  The primary failure rate for arteriovenous fistula (AVF) creation under local anesthesia for hemodialysis is about 30%. Axillary brachial plexus block (BPB) may improve blood flow through blood vessels used in fistula creation; it may improve the AVF blood flow and thus may reduce the primary failure rate after 3 months.
  
  
  METHODS
  Hundred and forty patients with chronic renal failure scheduled for AVF creation for hemodialysis were divided into two equal groups; Group 1 (AxBP-G) received ultrasound (US) guided axillary BPB, and Group 2 (LI-G) received local infiltration. We recorded the measurements of the brachial and radial arteries before and after anesthesia and the AVF blood flow in both groups at three different time points. Furthermore, the primary failure rate was recorded in each group and compared.
  
  
  RESULTS
  After anesthesia, the mean radial artery blood flow in the AxBP-group was 3.52 ml/min more than the LI-group, and the brachial artery diameter was also 0.68 mm more than in the LI-group, both differences were statistically significant (P< 0.05). There were significant increases (P< 0.05) in the AVF blood flow in the AxBP-group more than the LI-group with mean differences of 29.6, 69.8, and 27.2 ml/min at 4 h, 1 week, and 3 months, respectively. The overall mean of AVF blood flow was 42.21 ml/min more in the AxBP group than the LI-group a difference which is statistically significant (P< 0.001). The primary failure rate was 17% in the AxBP group versus 30% in the LI-group; however, this difference is not significant statistically (P= 0.110).
  
  
  CONCLUSIONS
  The US-guided axillary block increases AVF blood flow significantly more than local infiltration and nonsignificantly decreases the primary failure rate of the AVF after 3 months.
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: W H
authors.initials: WH
authors.lastname: Nofal
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: S M
authors.initials: SM
authors.lastname: El Fawal
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: A A
authors.initials: AA
authors.lastname: Shoukry
authors.affiliation: Department of Radio-diagnosis, National Centre of Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt.
authors.forename: Eas
authors.initials: E
authors.lastname: Sabek
authors.affiliation: Department of Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Wfa
authors.initials: W
authors.lastname: Malak
keywords: Arteriovenous fistula; axillary block; local infiltration; ultrasound-guided