Department of Nephrology, The Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Zhejiang, Hangzhou, China.
The First Clinical Medical of Zhejiang Chinese Medicine University, Zhejiang, Hangzhou, China.
BMC Anesthesiol. 2020 Aug 31;20(1):219. doi: 10.1186/s12871-020-01136-1.
Arteriovenous fistulae (AVF) are the hemodialysis access modality of choice for patients with end-stage renal disease. However, they have a high early failure rate. Good vascular access is essential to manage long-term hemodialytic treatment, but some anesthesia techniques directly affect venous diameter as well as intra- and post-operative blood flow. The main purpose of this meta-analysis was to compare the results of regional and local anesthesia (RA and LA) for arteriovenous fistula creation in end-stage renal disease.
We conducted a systematic review and meta-analysis to synthesize evidence from 7 randomized controlled trials (565 patients) and 1 observational study (408 patients) with the aim of evaluating the safety and efficacy of RA versus LA in surgical construction of AVF.
Pooled data showed that RA was associated with higher primary patency rates than LA (odds ratio [OR], 1.88; 95% confidence interval [CI]: 1.24-2.84; P = 0.003; I = 31%). Additionally, brachial artery diameter was significantly increased in the RA versus LA group (mean difference [MD], 0.83; 95% CI: 0.75-0.92; P < 0.001; I = 97%) and the need for intra- as well as post-operative pain killers was significantly less (RA, P = 0.0363; LA, P = 0.0318). Moreover, operation duration was significantly reduced using RA versus LA (MD, - 29.63; 95% CI: - 32.78 - -26.48; P < 0.001; I = 100%).
This meta-analysis suggests that RA is preferable to LA in patients with end-stage renal disease in guaranteeing AVF patency and increasing brachial artery diameter.
动静脉瘘（AVF）是终末期肾病患者首选的血液透析通路方式。然而，它们的早期失败率很高。良好的血管通路对于管理长期血液透析治疗至关重要，但一些麻醉技术会直接影响静脉直径以及术中及术后的血流量。本荟萃分析的主要目的是比较区域麻醉（RA）和局部麻醉（LA）在终末期肾病患者动静脉瘘创建中的结果。
我们进行了系统评价和荟萃分析，综合了 7 项随机对照试验（565 例患者）和 1 项观察性研究（408 例患者）的证据，旨在评估 RA 与 LA 在 AVF 手术构建中的安全性和有效性。
汇总数据显示，RA 与 LA 相比，初次通畅率更高（比值比 [OR]，1.88；95%置信区间 [CI]：1.24-2.84；P = 0.003；I²=31%）。此外，RA 组肱动脉直径明显增大（平均差值 [MD]，0.83；95%CI：0.75-0.92；P < 0.001；I²=97%），术中及术后止痛药的需求明显减少（RA，P = 0.0363；LA，P = 0.0318）。此外，RA 组手术时间明显缩短（MD，-29.63；95%CI：-32.78 - -26.48；P < 0.001；I²=100%）。
本荟萃分析表明，在保证动静脉瘘通畅性和增加肱动脉直径方面，RA 优于 LA 在终末期肾病患者中的应用。
