CardioVascular and Interventional Radiology

, Volume 39, Issue 10, pp 1407–1412 | Cite as

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

  • Emiko Chiba
  • Kohei Hamamoto
  • Michio Nagashima
  • Katsuhiko Matsuura
  • Tomohisa Okochi
  • Keisuke Tanno
  • Osamu Tanaka
Clinical Investigation
  • 384 Downloads

Abstract

Purpose

To evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.

Subjects and Methods

Twenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.

Results

The mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.

Conclusion

US-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.

Level of Evidence

Level 4 (case series).

Keywords

Hemodialysis Percutaneous transluminal angioplasty Ultrasound-guided axillary brachial plexus block 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis. 2015;66:884–930.CrossRefGoogle Scholar
  2. 2.
    Vesely TM. Percutaneous transluminal angioplasty for the treatment of failing hemodialysis grafts and fistulae. Semin Dial. 1998;11:103–10.Google Scholar
  3. 3.
    Hachiya A, Nozaki T, Watanabe T, Inaba S, Kurata K. Pain relief using midazolam during percutaneous transluminal angioplasty and evaluation of its optimal dosage in hemodialysis patients. Jpn Soc Dial Ther. 2015;48(2):123–8.CrossRefGoogle Scholar
  4. 4.
    Skehan SJ, Malone DE, Buckley N, et al. Sedation and analgesia in adult patients: evaluation of a staged-dose system based on body weight for use in abdominal interventional radiology. Radiology. 2000;216:653–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Martin ML, Lennox PH. Sedation and analgesia in the interventional radiology department. J Vasc Interv Radiol. 2003;14:1119–28.CrossRefPubMedGoogle Scholar
  6. 6.
    Johnson S. Sedation and analgesia in the performance of interventional procedures. Semin Interv Radiol. 2010;27:368–73.CrossRefGoogle Scholar
  7. 7.
    Beathard GA, Urbanes A, Litchfield T, Weinstein A. The risk of sedation/analgesia in hemodialysis patients undergoing interventional procedures. Semin Dial. 2011;24:97–103.CrossRefPubMedGoogle Scholar
  8. 8.
    Rueb GR, Brady WJ, Gilliland CA, et al. Characterizing cardiopulmonary arrest during interventional radiology procedures. J Vasc Interv Radiol. 2013;24:1774–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Nadolski G, Praestgaard A, Shlansky-Goldberg RD, et al. Medical emergencies and cardiopulmonary arrests in interventional radiology. J Vasc Interv Radiol. 2013;24:1779–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Ranganath A, Srinivasan KK, Iohom G. Ultrasound guided axillary brachial plexus block. Med Ultrason. 2014;3:246–51.Google Scholar
  11. 11.
    Hebl JR. Mayo Clinic atlas of regional anesthesia and ultrasound-guided nerve blockade. New York: Oxford University; 2010. p. 191–272.CrossRefGoogle Scholar
  12. 12.
    Klaastad Ø, Smedby O, Thompson GE, et al. Distribution of local anesthetic in axillary brachial plexus block: a clinical and magnetic resonance imaging study. Anesthesiology. 2002;96:1315–24.CrossRefPubMedGoogle Scholar
  13. 13.
    Schwemmer U, Markus CK, Greim CA, Brederlau J, Roewer N. Ultrasound-guided anaesthesia of the axillary brachial plexus: efficacy of multiple injection approach. Ultraschall Med. 2005;26(2):114–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Schafhalter-Zoppoth I, Gray AT. The musculocutaneous nerve: ultrasound appearance for peripheral nerve block. Reg Anesth Pain Med. 2005;30(4):385–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Wada J, Sakura S. US-guided nerve blocks: practice of upper extremity nerve blocks: Brachial plexus blocks. J Jpn Soc Clin Anesth. 2013;33(3):493–500.CrossRefGoogle Scholar
  16. 16.
    Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Sites BD, Beach ML, Spence BC, et al. Ultrasound guidance improves the success rate of a perivascular axillary plexus block. Acta Anaesthesiol Scand. 2006;50:678–84.CrossRefPubMedGoogle Scholar
  18. 18.
    Mouquet C, Bitker MO, Bailliart O, et al. Anesthesia for creation of a forearm fistula in patients with end stage renal failure. Anesthesiology. 1989;70:909–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Malinzak EB, Gan TJ. Regional anesthesia for vascular access surgery. Anesth Analg. 2009;109:976–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Laskowski IA, Muhs B, Rockman CR, et al. Regional nerve block allows for optimization of planning in the creation of arteriovenous access for hemodialysis by improving superficial venous dilatation. Ann Vasc Surg. 2007;21:730–3.CrossRefPubMedGoogle Scholar
  21. 21.
    O’Donnell BD, Ryan H, O’Sullivan O, Iohom G. Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial. Anesth Analg. 2009;109(1):279–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Davis WJ, Lennon RL, Wedel DJ. Brachial plexus anesthesia for outpatient surgical procedures on an upper extremity. Mayo Clin Proc. 1991;66(5):470–3.CrossRefPubMedGoogle Scholar
  23. 23.
    Janzen PR, Vipond AJ, Bush DJ, Hopkins PM. A comparison of 1% prilocaine with 0.5% ropivacaine for outpatient-based surgery under axillary brachial plexus block. Anesth Analg. 2001;93(1):187–91.CrossRefPubMedGoogle Scholar
  24. 24.
    Takasaki M, Yamamoto K, Saito Y. Clinical evaluation of 5.0 mg/mL levobupivacaine hydrochloride (MR8A2), a long-acting local anesthetic, for peripheral nerve block (brachial plexus block). Anesth Resusc. 2011;47:109–18.Google Scholar
  25. 25.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Neal JM, Gerancher JC, Hebl JR, et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134–70.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Gedikoglu M, Andic C, Eker HE, Guzelmansur I, Oguzkurt L. Ultrasound-guided supraclavicular brachial plexus block for analgesia during endovascular treatment of dysfunctional hemodialysis fistulas. J Vasc Interv Radiol. 2014;25:1427–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  1. 1.Department of Radiology, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
  2. 2.Department of Emergency MedicineAsahikawa Medical UniversityAsahikawaJapan

Personalised recommendations