REGIONAL ANAESTHESIA FOR PERCUTANEOUS PERITONEAL DIALYSIS CATHETER INSERTION BY NEPHROLOGISTS USING ULTRASOUND GUIDED RECTUS SHEATH BLOCK

YEO W1,2, POTTER D2,3, NARAYANAN G3, ARAVINDAN A3, NANDAKOBAN H2,3, WONG J3

1South Western Sydney Clinical School, Sydney, Australia , 2University of New South Wales, Sydney , Australia , 3Renal Unit Liverpool Hospital, Sydney, Australia

Aim: To describe percutaneous peritoneal dialysis catheter (PPDC) insertion using ultrasound guided rectus sheath block (RSB) by nephrologists in an ambulatory setting.

Background: Analgesia for PPDC insertion concerns patients and proceduralist but is rarely described. RSB provides effective somatic analgesia for midline incisions. Our centre transitioned to oral premedication and Xylocaine 1% with Adrenaline 1:100000, as subcutaneous local anaesthesia (variable dose) and regional anaesthesia with RSB (fixed dose 10mls) for PPDC insertion in 2018.

Methods: A single centre retrospective review of PPDC insertions using RSB from January 2018 to April 2021. Patient, operator, procedural characteristics and post procedural outcomes including Kaplan-Meier survival were analysed with SPSS v.26.

Results: We identified 113 patients: 73% male, 58% Diabetic, median age 66 years (interquartile range(IQR)56-73), 87% pre-dialysis with median eGFR 8mls/min/1.73m2 (IQR=7-10). Most (95%) patients received formalized pre-procedure review: 37% had previous abdominal surgery, mean body mass index was 26.2kg/m2 (range=19-38) and median abdominal wall depth was 2.9cm (IQR=2.4-3.8). There were 64% same day discharges. Primary proceduralists were trainees in 34% cases.  Median total Xylocaine with Adrenaline dose was 24.5mls (IQR=20-25). Insertion success was 99% with 96% flushing well post-procedure, 1 catheter failed <30 days. Acute start dialysis was commenced in 8 patients. Complications <30 days included: 2 cases of severe pain (1 due to mesenteric injury), 3 cases of bleeding and 1 catheter manipulation. Death and transplant censored primary catheter survival was 89% and 87% at 6 and 12 months respectively. The incidence of peritoneal dialysis peritonitis was 1 in 33 patient months.

Conclusions: PPDC insertion employing RSB performed by nephrologists and trainees in an ambulatory setting is simple and safe with good short and long-term outcomes.


Biography:

Wai Weng is a 5th year medical student from University of New South Wales, currently based in Liverpool Hospital, Sydney. He has a strong interest in renal medicine.

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