Intravenous Regional Anesthesia (Bier Block) Method for Arteriovenous Fistula creation in patients with End Stage Renal Disease

  Introduction: Hemodialysis through creation of arteriovenous fistula (AVF) is an established surgical procedure for patients with End Stage Renal Disease (ESRD). Anesthetic methods management for this surgery should deal with different risk factors such as hypertension, ischemic heart disease and diabetes. Intravenous Regional Anesthesia (IVRA) or Bier block anesthesia as an option for AVF creation has reportedly been attributed to some advantages over other techniques in AVF creation. The present study aims to evaluate the efficacy of Bier block in AVF creation and compare its efficacy with local anesthesia.    Methods: The subjects of the study were the patients (n=60, aged 20-65 years), who had been admitted for an AVF creation. The patients were divided into two randomly assigned matched groups: Local Anesthesia (LA) group and Intravenous Regional Anesthesia (IVRA) group.    Results: The patients’ satisfaction levels, simplicity and feasibility of the procedure in the IVRA group were higher, compared to the LA group (94.1%, 66.7%, and 4.85% vs. 82.8%, 51.7% and 3.5%, respectively). However, these differences were not statistically significant.   Conclusions: The two main advantages of Bier block technique are the simplicity of operation and provision of a bloodless field for surgeon. It provides maximum dilatation in veins through the injection of the anesthetic drug and placing a tourniquet on it.