关键词: 超声引导下经皮腔内血管成形术, 表面麻醉, 局部浸润麻醉, 高选择性局部神经阻滞

Abstract: Objective To compare the analgesic effect of different anesthetic methods in ultrasound-guided percutaneous transluminal angiography （PTA） therapy for dialysis arteriovenous fistula （AVF） stenosis. Methods Ultrasound-guided PTA was performed on 93 hemodialysis patients with AVF stenosis from October 2017 to July 2019. Patients were randomized into four groups：no anesthesia group（n = 20），surface anesthesia group （n = 27），local infiltration anesthesia（n = 22），high selective local nerve block anesthesia group（n = 24），to observe the anesthesia effect，the operating time（including onset and duration）and the postoperative complications. Results The pain score of the no anesthesia group and surface anesthesia group were significantly higher than the other two groups. The pain score of the no anesthesia group was the highest，which was significantly higher than that of the other anesthesia groups. The pain score of the surface anesthesia group was in the middle，which was significantly higher than that of the highly selective local nerve block group and the local infiltration anesthesia group. There was no significant difference in pain score between the highly selective local nerve block group and the local infiltration anesthesia group. In terms of anesthesia time，the highly selective local nerve block group had the longest operation time， which significantly prolonged the operation time. During the observations of postoperative complications，one case of local erythema occurred in the surface anesthesia group，two cases of blood vessel injuries occurred in the local infiltration anesthesia，and one case of intramuscular hematoma occurred in the highly selective local nerve block group. Conclusion Local infiltration anesthesia and high selective local nerve block anesthesia are well tolerated for patients' surgical pain，but should be noted to avoid complications. Although the two groups have obviously better analgesic effects，in the highly selective local nerve block group，the operation time has markedly prolonged. Surface anesthesia has limited analgesic effects， and could be used for patients who are fewer sensitive to pain. There are no severe complications in the three anesthetic methods.

Key words: ultrasound-guided percutaneous transluminal angiography therapy, surface anesthesia, local infiltration anesthesia, high selective local nerve block