The Efficacy of Ultrasound-Guided Selective Nerve Block in the Endovascular Treatment of Arteriovenous Fistulas.

Abstract

Introduction Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access. Methods 246 patients with dysfunctional radiocephalic arteriovenous fistula undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022 to August 31, 2023. The patients were randomized into either the selective nerve block group (SNB group, n=123) or the local anesthesia group (LA group, n=123) . A visual analogue scale(VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The arteriovenous fistula patency at 1 and 3 months after PTA was also evaluated. Results Compared with the local anesthesia group, the selective nerve block group had significantly lower VAS scores (Z = -7.193, p < 0.001) and required fewer additional anesthetics during the operation (² = -4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the selective nerve block group (p < 0.05). Eight patients in the selective nerve block group encountered grade 3 motor paralysis after the operation and they all recovered within 60 minutes. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05). Conclusion Compared with local anesthesia, ultrasound-guided selective nerve block has advantages over the local anesthesia during endovascular treatment of dysfunctional hemodialysis fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in hemodialysis patients.