Regional Versus Local Anaesthesia for Haemodialysis Arteriovenous Fistula Formation: A Systematic Review and Meta-Analysis

Background Arteriovenous fistula (AVF) formation is the most common vascular access procedure for patients requiring haemodialysis. However, it is associated with high failure rates, influenced by vessel diameter and arterial inflow. Mode of anaesthesia may affect these factors, and subsequently AVF maturation rates. Objective To perform a systematic review and meta-analysis to assess the effect of anaesthesia type for autologous primary radiocephalic or brachiocephalic AVF creation on subsequent fistula failure rates. Methods The online databases of Medline, EMBASE, CINAHL, The Cochrane Database of Systematic Reviews, ClinicalTrials.gov , and Google Scholar as well as vascular and anaesthesiology conference abstracts were searched on August 1, 2016. Randomised control trials (RCTs) that reported the effect of anaesthesia type on subsequent failure rates during autologous AVF creation were included. Two independent reviewers performed methodological assessment and data extraction. Random effects models were used to calculate pooled effect size estimates. A sensitivity analysis was also carried out. Results Four RCTs (286 patients) were identified with 286 autologous AVFs. There were 48 fistula failures. Most of the studies suffered from significant methodological flaws. There was a significantly lower failure rate among patients undergoing regional (12/143) compared with local (36/143) anaesthesia (OR 0.28, 95% CI 0.14–0.57). On sensitivity analysis, having excluded the most heavily weighted study, the results remained significant (OR 0.20, 95% CI 0.05–0.75). Conclusions The use of regional anaesthesia is associated with lower AVF failure rates when compared with local anaesthesia in patients undergoing primary forearm AVF formation for haemodialysis.