Newswise — Researchers studying the use of a ‘regional’ rather than a local anesthetic technique at the time of surgery found the regional anesthetic technique increased the success of the surgery even one year after the operation.

The study examined patients who received a surgically created “fistula” to enable dialysis forend-stage kidney failure. The fistula creates a connection between an artery and vein, usually in the patient's arm. Unfortunately, a percentage of these surgical fistulas fail, requiring further operations. The randomized controlled trial showed that fistula success can be improved depending on the anesthetic technique used, with a regional anesthetic technique being better than a local anesthetic.

Primary author Dr Alan Macfarlane, MD, of Glasgow Royal Infirmary in Scotland, explained that although the patient remains awake with both techniques the regional anesthetic technique, which involves using an ultrasound-guided injection, numbs the whole arm. The local anesthetic simply freezes up the small surgical site. “The regional technique has the advantage of increasing the size of and improving flow through vessels during (and for several hours) after the operation,” he said. This in turn may make surgery easier, and also reduce early clotting (and subsequent failure) of the fistula.

Initial results of the study, published in The Lancet, reported that more fistulas were working at three months after the operation. Macfarlane and colleagues Drs. Emma Aitken, Andrew Jackson, Rachel Kearns, John Kinsella, and Marc Clancy, are now reporting on data after one year, which continues to support use of the technique.

“This is one of the first randomized studies to show a benefit on surgical outcome lasting up to one year related to solely to the anesthetic,” Dr Macfarlane said. “Our findings have the potential to deliver significant patient (and hospital cost) benefits worldwide by reducing the number of redo fistula operations through using regional anesthesia.”

Dr Macfarlane has received one of three “Best of Meeting Abstract Awards” from the American Society of Regional Anesthesia and Pain Medicine. He will present “Does Regional Compared to Local Anaesthesia Influence Outcome after Arteriovenous Fistula (AVF) Creation? One Year Follow-up of a Randomised Controlled Trial” on Saturday, April 21, at 10:15 am.

The 2018 World Congress on Regional Anesthesia and Pain Medicine will be held April 19-21 at the New York Marriott Marquis in Times Square. The meeting brings together five intercontinental regional anesthesia and pain medicine societies every four years. This is the first time the meeting will be held in the United States, with nearly 3,000 expected to attend.


Meeting Link: 2018 World Congress on Regional Anesthesia & Pain Medicine