More than 2500 people in Australia start hemodialysis for kidney failure every year. The preferred surgical technique for establishing haemodialysis is through a native arteriovenous fistula (AVF), however this is beset with high AVF patency loss over time. Based on observational studies, a brachial plexus block (BPB) may improve AVF patency compared to general anaesthesia (GA). However, no well-designed pragmatic randomised controlled trial (RCT) has compared BPB to GA with regards to AVF patency, and both techniques are still commonly employed.
The primary objective of the study is to determine if it is feasible to conduct a pragmatic multi-centre RCT comparing BPB to GA. Secondarily, to compare BPB to GA with regards to: a range of definitions of AVF patency; cost-utility measures; and adverse events.
The study is a multi-centre assessor-blinded randomised controlled trial (RCT). Inclusion criteria: all consented adult patients with planned de novo creation of upper limb AVF. Exclusion criteria: pregnancy, clinician refusal, contraindications to BPB. Randomised patients will receive either a brachial plexus block (any approach) or GA requiring instrumentation of the airway. Endpoints will be measured at 24 hours, 4-6 weeks, 12 week and 24 weeks.
This study has the potential to establish best practice for AVF creation that is meaningful to patients.
Dr Raymond Hu, Professor Philip Peyton, Associate Professor Peter Mount, Associate Professor Jason Chuen Austin Health, Vic, Dr Andrea Viecelli, Princess Alexandra Hospital, Brisbane.
The project was awarded $A58,674 through the ANZCA research grants program for 2022.