ABSTRACT
The goal of the study was to compare effectiveness of regional and local anesthesia in dialysis arterio-venous fistula (AVF) operations. It was a prospective, randomized study. 103 patients with end stage renal disease underwent AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Duplex sonography evaluation of upper arm vessels was performed pre-operatively and at 1, 3 and 6 months postoperatively. Following parameters were measured on duplex scan: vessel diameter, blood flow rates (PSV and EDV), resistive index (RI) and pulsatility index (PI). Significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group. Time to postoperative pain initiation, need for postoperative pain killers was significantly better in Group II as compared with the Group I. Duration of operation was significantly less in regional as compared with local anesthesia. Postoperative PSV and EDVs were negatively correlated with patient age. The fistula maturation time was positively correlated with age. The vein diameter, postoperative PSV and EDV have been significantly increased in Group I as compared with Group II. The postoperative PI has significantly increased and RI has significantly decreased in Group I as compared with Group II. The total number of dialysis punctures was higher in regional as compared with the local anesthesia. Regional anesthesia provides significantly better analgesia as compared with the local anesthesia in AVF operations. It significantly improves the duplex sonography parameters after AVF formation. It can be a method of choice for some forms of fistulas.
Subject(s)
Anesthesia, Local/methods , Arteriovenous Fistula/surgery , Kidney Failure, Chronic/surgery , Pain, Postoperative/prevention & control , Renal Dialysis , Age Factors , Aged , Anesthetics, Local , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/pathology , Blood Flow Velocity , Female , Humans , Kidney Failure, Chronic/diagnostic imaging , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Lidocaine , Male , Middle Aged , Operative Time , Pain, Postoperative/physiopathology , Prospective Studies , Ropivacaine , Ultrasonography, Doppler, DuplexABSTRACT
Both, regional and local anesthesia are used for dialysis arterio-venous fistula (AVF) formation in end-stage renal disease patients. There are no prospective, randomized clinical trials comparing effectiveness of these types of anesthesia in these patients. It was a prospective, randomized study. 103 patients with ESRD underwent dialysis AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Radio-Cefalic, Brachio-Cefalic and Brachio-Basilic(I stage transposition) fistulas have been created in all patients.Influence of the type of anesthesia on intra- and postoperative pain has been evaluated and compared between the groups. The mean follow-up was 359.5 days in Group I and 340.5 days in Group II (p-NS).The mean patients age was 59.7±13.1 years and 60.1±14 years in local and regional anesthesia groups, respectively (p=NS). For the whole group, significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group (p=0.0363). Time to postoperative pain initiation was significantly higher in Group II (2.3 hours) as compared with the Group I (1.7 hours, p=0.0477). The need for postoperative pain killers was significantly less in regional as compared with the local anesthesia (p=0.0318). Duration of operation was significantly less in regional (67.5 min.) as compared with local anesthesia (134.7 min. p=0.0007) group. This difference has been detected in Brachio-Cefalic and Brachio-Basilic fistulas (p=0.0257 and 0.001, respectively) but not in Radio-Cefalic one. No anesthesia related complications have been detected. Insufficiency of regional anesthesia has been identified in 3 cases (5.5%).In 5 patients from regional anesthesia group (9.4%) as a result of vasodilation have made more simplified operation. Regional anesthesia provides significantly betterperiperativeanalgesiaas compared with the local anesthesia in AVF operations. It can change the tactic of surgery, significantly decreases the operation time and should be a method of choice for some forms AVF operations.
Subject(s)
Anesthesia, Conduction/methods , Anesthesia, Local/methods , Arteriovenous Fistula/therapy , Renal Insufficiency, Chronic/therapy , Aged , Female , Humans , Kidney Failure, Chronic , Male , Middle Aged , Prospective Studies , Renal Dialysis , Renal Insufficiency, Chronic/physiopathologyABSTRACT
Highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with HIV. As a result, kidney transplantation is considered an viable treatment option for HIV infected patients with end stage renal disease. The first living-related kidney transplant in Georgia has been performed between non-identical twin sisters in July 2013. In this paper we give the detailed case report and short overview of the existing literature. This is the first report of the successful kidney transplant in HIV infected patient in East Europe and former Soviet Union Countries including the Central Asia.
