Bahador Oshidari
1 
, Malihe Abniki
2 , Mohsen Soori
3* 1 Department of General Surgery, School of Medicine, Imam Hossein Hospital, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Anesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of General Surgery, School of Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Hemodialysis catheter placement is a critical procedure for patients with end-stage renal disease, often performed under varying anesthesia modalities depending on clinical context, patient comorbidities, and institutional protocols. This narrative review explores the comparative use of local, regional, and general anesthesia in the placement of tunneled and non-tunneled hemodialysis catheters. Drawing on studies indexed in reputable databases, we evaluated the efficacy, safety, procedural success, and patient-centered outcomes associated with each technique. Special attention is given to high-risk populations, including the elderly, pediatric patients, and those in critical care settings. Our findings suggest that while local anesthesia remains the most commonly used and resource-efficient approach, regional and general anesthesia may offer advantages in select populations, particularly where patient cooperation or procedural complexity is a concern. The review highlights the need for individualized anesthesia planning and calls for further prospective studies to establish evidence-based guidelines.
Implication for health policy/practice/research/medical education:
In this review study, we found that the choice of anesthesia for hemodialysis catheter placement should be individualized. Local anesthesia with sedation remains appropriate and efficient for most elective, cooperative patients due to its safety, rapid recovery, and resource advantages, while regional blocks provide superior analgesia and tolerance for patients with high anxiety, difficult anatomy, or when longer or more complex tunneling is required; general anesthesia is reserved for uncooperative patients, children, or when concurrent procedures mandate airway control. Clinically, practitioners should assess patient comorbidity, coagulation status, procedural complexity, and institutional resources, apply ultrasound guidance to optimize block success and reduce complications, and document anesthesia choice in a standardized protocol to improve patient comfort, procedural success, and throughput.
Please cite this paper as: Oshidari B, Abniki M, Soori M. Local, regional, or general; a narrative review of anesthesia modalities for hemodialysis catheter placement. J Nephropharmacol. 2026;15(x):e12826. DOI: 10.34172/npj.2026.12826.