Efficacy and safety of brachial plexus block versus local infiltration anesthesia for percutaneous transluminal angioplasty in dialysis access: a systematic review and meta-analysis

To determine whether brachial plexus block (BPB) or local infiltration anesthesia (LIA) provides better efficacy, safety, and patient satisfaction in adults undergoing percutaneous transluminal angioplasty (PTA) for dialysis access. We searched PubMed, Embase, the Cochrane Library, CBM, CNKI, VIP, and Wanfang Data for clinical trials comparing LIA and BPB during PTA for dialysis access. Two independent reviewers performed risk of bias assessment and data extraction. Random-effect models and fixed-effect models were used to calculate pooled effect size estimates. We enrolled 912 patients across eight trials (four cohort studies and four randomized controlled trials). BPB was associated with significantly lower intraoperative (MD= -2.99, P < 0.01) and postoperative Visual Analogue Scale (VAS) pain scores (MD= -2.47, P < 0.05), higher patient satisfaction scores (SMD = 0.82, P < 0.05, though this finding was not robust in sensitivity analyses), and improved 6- (OR = 3.07, P < 0.05) and 12-month primary-assisted patency rates (OR = 2.86, P < 0.05). There was no difference in 3- (OR = 1.08, P > 0.05), 6- (OR = 1.12, P > 0.05), and 12-month primary patency rates (OR = 1.15, P > 0.05) and surgical time (MD= -1.09, P > 0.05) between both anesthetic modalities. There was no statistically significant difference in adverse events between the two groups (5.63% vs. 7.25%, P = 0.53). Compared with LIA, BPB was associated with better pain control and higher patient satisfaction, though the latter finding was not robust in sensitivity analyses. An exploratory association with improved primary-assisted patency was also observed, but this finding is observational and should be interpreted with caution. Both modalities showed comparable primary patency and surgical time. However, the generalizability may be limited to East Asian populations. PROSPERO (CRD42023429884).