Background and Aims Regional anesthesia has become an increasingly popular approach in arteriovenous fistula(AVF) creation surgery, due to the higher primary patency rates. The sympathectomy-like effect of brachial plexus block may cause perioperative vasodilation and increased brachial artery blood flow. This study aimed to estimate the minimum effective anesthetic concentration of lidocaine required for ultrasound-guided axillary nerve block in 90% (MEAC90) of patients with chronic kidney disease undergoing AVF creation surgery.
Methods This study was based on a biased coin design up-and-down sequential method. Patients undergoing primary AVF creation surgery were enrolled. Ultrasound-guided perineural axillary block was performed with 20 ml 0.9% lidocaine. The following concentration was determined by the result of the previous patient. If the patient underwent the operation under pure nerve block, the next patient was randomized to receive the same lidocaine concentration or a concentration of 0.1% less. However, if the rescue medications were required, the lidocaine concentration was increased by 0.1% in the next patient.
Results Thirty participants were enrolled, with 25 positive responses and 5 negative responses that needed additional medications during the operation. The mean MEAC90 was estimated to be 1.13% [95% confidence interval, 1.098-1.173].
Conclusions In the current preliminary study, ultrasound-guided injection of 20ml of 1.13% lidocaine through perineural axillary block could provide a successful block for AVF creation surgery in 83.3% patients.
Ethics Committee Approval from FEMH
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