Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis
Post author correction
Article Type: REVIEW
Article Subject: Dialysis
DOI:10.5301/jva.5000683
Authors
Ammar Ismail, Abdelrahman Ibrahim Abushouk, Amira H. Bekhet, Osama Abunar, Omar Hassan, Ahmed A. Khamis, Mohamed Al-sayed, Ahmed ElgebalyAbstract
There is a consensus in the literature that regional anesthesia (RA) improves local hemodynamic parameters in comparison to local anesthesia (LA) during arteriovenous fistula (AVF) surgical construction. However, the effects of both techniques on fistula patency and failure rates are still controversial. The aim of this meta-analysis is to synthesize evidence from published randomized trials and observational studies regarding the safety and efficacy of RA versus LA in AVF surgical construction. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central retrieved six randomized trials (462 patients) and one retrospective study (408 patients). Pooling data using RevMan software (version 5.3) showed that RA was superior to LA in terms of primary fistula patency rate (RR = 1.22, 95% CI [1.08, 1.37], p = 0.0010); however, both types were comparable in terms of primary fistula failure rate (RR = 0.81, 95% CI [0.47, 1.40], p = 0.46). In comparison to LA, RA was associated with improved hemodynamic parameters including fistula blood flow (MD = 25.08, 95% CI [19.40, 30.76], p<0.00001), brachial artery diameter (SMD = 2.63, 95% CI [2.17, 3.08], p<0.00001), and outflow venous diameter (SMD = 0.93, 95% CI [0.30, 1.75], p = 0.004). Postoperative complications were comparable between both groups (OR = 0.23, 95% CI [0.05, 0.97], p = 0.05). In conclusion, RA was associated with higher primary patency rates of AVF and improved local blood flow in comparison to LA; however, both procedures were comparable in terms of primary failure rates and postoperative complications. Larger well-designed trials with longer follow-up periods should compare both techniques in terms of long-term patency rates and safety outcomes.
Article History
- • Accepted on 28/12/2016
- • Available online on 05/05/2017
Disclosures
This article is available as full text PDF.
Authors
- Ismail, Ammar [PubMed] [Google Scholar] 1, 2, 3, * Corresponding Author (Ammaryasser3240@azhar.edu.eg)
- Ibrahim Abushouk, Abdelrahman [PubMed] [Google Scholar] 2, 4
- Bekhet, Amira H. [PubMed] [Google Scholar] 3, 5
- Abunar, Osama [PubMed] [Google Scholar] 6
- Hassan, Omar [PubMed] [Google Scholar] 7
- Khamis, Ahmed A. [PubMed] [Google Scholar] 8
- Al-sayed, Mohamed [PubMed] [Google Scholar] 8
- Elgebaly, Ahmed [PubMed] [Google Scholar] 1
Affiliations
- Faculty of Medicine, Al-Azhar University, Cairo - Egypt
- NovaMed Medical Research Association, Cairo - Egypt
- Medical Research Group of Egypt, Cairo - Egypt
- Faculty of Medicine, Ain Shams University, Cairo - Egypt
- Faculty of Physical Therapy, Cairo University, Cairo - Egypt
- Faculty of Medicine, Mansoura University, Mansoura - Egypt
- Faculty of Medicine, Al Azhar University, Assiut - Egypt
- Faculty of Medicine, Alexandria University, Alexandria - Egypt
- Ammar Ismail and Abdelrahman Ibrahim Abushouk contributed equally to this work
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