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

• Published in: CardioVascular and Interventional Radiology Vol. 39; no. 10; pp. 1407 - 1412
• Main Authors: Chiba, Emiko, Hamamoto, Kohei, Nagashima, Michio, Matsuura, Katsuhiko, Okochi, Tomohisa, Tanno, Keisuke, Tanaka, Osamu
• Format: Journal Article
• Language: English
• Published: New York Springer Science and Business Media LLC 01.10.2016; Springer US; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Analgesia; Analgesia - methods; ANESTHESIA; Angioplasty; Angioplasty - methods; Arteriovenous Fistula; Arteriovenous Fistula - therapy; Brachial Plexus; Brachial Plexus Block; Brachial Plexus Block - methods; BYPASSES; Cardiology; Clinical Investigation; COMPARATIVE EVALUATIONS; DIALYSIS; Female; FISTULAE; Forearm; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; NERVES; Nuclear Medicine; PAIN; Pain - drug therapy; PATIENTS; Prospective Studies; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Renal Dialysis; SAFETY; TRANSIENTS; Treatment Outcome; Ultrasonography, Interventional; Ultrasonography, Interventional - methods; Ultrasound; VASCULAR DISEASES; Hemodialysis; Percutaneous transluminal angioplasty; Ultrasound-guided axillary brachial plexus block
• ISSN: 0174-1551; 1432-086X; 1432-086X
• DOI: 10.1007/s00270-016-1409-z

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).