Abstract
Local anesthesia or brachial plexus block may not consistantly provide anes thesia for insertion of the prosthesis for a looped forearm arteriovenous shunt. Intravenous lidocaine regional anesthesia (Bier block) can provide excellent forearm anesthesia.
This study reports 22 cases of looped forearm prosthetic dialysis access shunts performed with Bier blocks. The average operative time was 108 min utes. Anesthesia was reliable and no complications occurred.
The grafts have been followed for 5 to 67 weeks with an average of 36 weeks followup. Two failures have occurred one due to infection, and a second with recurrent thrombosis. Three surviving grafts have required thrombectomy. The predicted 75th percentile survival period is 56 weeks.
Bier block anesthesia is consistent, causes venodilitation and allows surgery without vascular clamps or systemic heparinization all of which have assisted the operative procedure.
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