Comparison of Efficacy of Ultrasound-Guided Supraclavicular and Axillary Block for Arterio-Venous Fistula Creation: An Observer-Blinded, Non-inferiority Randomized Controlled Trial

Introduction An AV fistula creation is generally performed at the antecubital fossa under regional anesthesia. General anesthesia is associated with increased cardiorespiratory complications in patients with end-stage renal disease. Thus, in such patients, RA, such as a brachial plexus block (BPB), is favored for AVF creation. In this study comparison between two well-established and frequently used approaches of brachial plexus block: supraclavicular and axillary, will be compared.

The supraclavicular block is one of several approaches used for the brachial plexus block. The block is performed at the level of the brachial plexus trunks, where almost the entire sensory, motor, and sympathetic innervation of the upper extremity is carried in just three nerve structures confined to a very small surface area. Indications for the supraclavicular block include elbow, forearm, and hand surgeries.

The axillary block technique is relatively easy to approach and simple to perform and may be associated with a lower risk of complications than supraclavicular BPB. The supraclavicular has a slightly wider area of coverage and a supposedly higher rate of complications compared to the axillary approach when performed with a traditional approach without ultrasound guidance. Using ultrasound should reduce the rate of complications for both blocks. No randomized control study has compared the efficacy of both blocks for AV Fistula creation with ultrasound guidance. This study aims to determine a better anesthesia technique for AV fistula creation in terms of anesthesia efficacy, complications, and recovery.

Method

Study type: Randomized, Controlled, observer-blinded non-inferiority trial, with two parallel arms.