Long-term functional patency and cost-effectiveness of arteriovenous fistula creation under regional anesthesia: a randomized controlled trial

Aitken, E., Kearns, R. , Gaianu, L., Jackson, A., Steven, M., Kinsella, J., Clancy, M. and MacFarlane, A. (2020) Long-term functional patency and cost-effectiveness of arteriovenous fistula creation under regional anesthesia: a randomized controlled trial. Journal of the American Society of Nephrology, 31(8), pp. 1871-1882. (doi: 10.1681/ASN.2019111209) (PMID:32709710)

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Abstract

BACKGROUND:Regional anesthesia improves short-term blood flow through arteriovenous fistulas (AVFs). We previously demonstrated that, compared with local anesthesia, regional anesthesia improves primary AVF patency at 3 months. METHODS:To study the effects of regional versus local anesthesia on longer-term AVF patency, we performed an observer-blinded randomized controlled trial at three university hospitals in Glasgow, United Kingdom. We randomly assigned 126 patients undergoing primary radiocephalic or brachiocephalic AVF creation to receive regional anesthesia (brachial plexus block; 0.5% L-bupivacaine and 1.5% lidocaine with epinephrine) or local anesthesia (0.5% L-bupivacaine and 1% lidocaine). This report includes findings on primary, functional, and secondary patency at 12 months; reinterventions; and additional access procedures (primary outcome measures were previously reported). We analyzed data by intention to treat, and also performed cost-effectiveness analyses. RESULTS:At 12 months, we found higher primary patency among patients receiving regional versus local anesthesia (50 of 63 [79%] versus 37 of 63 [59%] patients; odds ratio [OR], 2.7; 95% confidence interval [95% CI], 1.6 to 3.8; P=0.02) as well as higher functional patency (43 of 63 [68%] versus 31 of 63 [49%] patients; OR, 2.1; 95% CI, 1.5 to 2.7; P=0.008). In 12 months, 21 revisional procedures, 53 new AVFs, and 50 temporary dialysis catheters were required. Regional anesthesia resulted in net savings of £195.10 (US$237.36) per patient at 1 year, and an incremental cost-effectiveness ratio of approximately £12,900 (US$15,694.20) per quality-adjusted life years over a 5-year time horizon. Results were robust after extensive sensitivity and scenario analyses. CONCLUSIONS:Compared with local anesthesia, regional anesthesia significantly improved both primary and functional AVF patency at 1 year and is cost-effective. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER:Local Anaesthesia versus Regional Block for Arteriovenous Fistulae, NCT01706354.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Kearns, Dr Rachel and Kinsella, Professor John and Aitken, Dr Emma and Clancy, Mr Marc and MacFarlane, Dr Alan
Authors: Aitken, E., Kearns, R., Gaianu, L., Jackson, A., Steven, M., Kinsella, J., Clancy, M., and MacFarlane, A.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of the American Society of Nephrology
Publisher:American Society of Nephrology
ISSN:1046-6673
ISSN (Online):1533-3450
Published Online:31 July 2020
Copyright Holders:Copyright © 2020 American Society of Nephrology
First Published:First published in Journal of the American Society of Nephrology 31(8):1871-1882
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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