Regional anesthesia with epinephrine‐containing lidocaine reduces pericatheter bleeding after tunneled hemodialysis catheter placement

• Published in: Hemodialysis international 2019-01, Vol.23 (1), p.26-32
• Main Authors: Mutlu, Ilhan Nahit, Kocak, Burak, Baykara Ulusan, Melis, Ulusan, Kivilcim, Cakir, Mehmet Semih, Kilickesmez, Ozgur
• Format: Article
• Language: English
• Subjects: Anesthetics; bleeding; catheter; epinephrine; hemodialysis; lidocaine
• ISSN: 1492-7535; 1542-4758
• DOI: 10.1111/hdi.12686

Introduction: Pericatheter bleeding (PB) following tunneled hemodialysis catheter (THC) placement is a common phenomenon. In addition to complicating securement of the THC, the PB may loosen the adhesive catheter dressing and delay wound healing. The primary aim of this study was to determine whether epinephrine‐containing local anesthetics rather than plain ones reduce superficial PB after THC placement. Methods: The study was based on the retrospective analysis of the prospectively gathered data. Forty‐six patients receiving local analgesia during THC placement were randomly assigned in a double‐blind manner to two groups according to local anesthetic mixtures used (n =22 to prilocaine group [group 1]; n =24 to epinephrine‐containing lidocaine group [group 2]). Presence or absence of PB after the THC placement was evaluated. Differences between groups with and without controlling other variables were statistically analyzed. Findings: Epinephrine‐containing lidocaine (group 2) significantly reduced PB in comparison with prilocaine, P = 0.003. Use of epinephrine‐containing lidocaine (group 2) was associated with a reduction in the likelihood of PB (Odds ratio = 0.017). Meanwhile, use of prilocaine (group 1) had 59.7 times higher odds in the likelihood of PB after THC placement. Lower rate of systolic blood pressure (SBP) in group 2 patients after 5 minutes of injections was also noted, P = 0.008. Epinephrine‐containing lidocaine was well tolerated and caused no significant cardiovascular disturbance. Discussion: Local infiltration of epinephrine‐containing lidocaine instead of plain local anesthetics during THC insertion may reduce superficial PB and improve patient comfort.