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182 A retrospective cohort study of brachial plexus blocks in vascular surgeries for hemodialysis access of kidney patients in a tertiary care center (2016–2019)
  1. A Rosales and
  2. N Aypa
  1. Makati Medical Center, Makati, Philippines


Background and Aims Brachial plexus blocks (BPB) have been used to provide surgical anesthesia in vascular procedures. Regional anesthesiologists must correlate technique with the procedure to establish protocols in performing peripheral nerve blocks in renal patients for hemodialysis. The primary objective of this study is to describe relationship between BPB used and the type of surgery done for hemodialysis access.

Methods This was a retrospective, analytical, observational, cohort type of study conducted through chart review of kidney patients at a tertiary care center approved by the IRB (Protocol Number 2021-003).

Results A total of 355 patients were included in this study where the median age was 64 years old. More than half of the cohort (57.18%) was male. Most of the subjects (93%) were classified as ASA category III. The most common surgical procedure for securing vascular access was arteriovenous fistula creation (39.72%) while the most common BPB performed was axillary approach (59.15%), followed by supraclavicular approach (19.44%), infraclavicular approach (14.93%) and interscalene approach (6.48%).

All four techniques recorded no incidence of inadequate block and only low incidence for need of rescue pain medication for infraclavicular (0.47, 95% CI: 0–10.01) and axillary (0.47, 95% CI: 0–2.62) blocks. This resulted to a low overall incidence of need of rescue pain medication at 0.56, 95% CI: 0–2.02.

Conclusions Axillary, infraclavicular and supraclavicular BPB are appropriate in procedures involving the wrist, distal arm and elbow (i.e., AV fistula creation). In procedures involving the arm such as AV graft creation and thrombectomy, infraclavicular, supraclavicular and interscalene BPB may be utilized.

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