Landmark- vs Ultrasound-Guided Intercostobrachial Nerve Block and Serratus Plane Block after Supraclavicular Plexus Block for Medial Arm AV Fistula Surgery: A Randomized Double-Blind Trial.

Background: Effective postoperative pain management is necessary to enhance patient recovery and satisfaction following the creation of an arteriovenous fistula (AVF). Objectives: This work compares the role of Ultrasound (US) guided and landmark-guided Intercostobrachial nerve (ICBN) block and serratus plane block (SPB) after supraclavicular plexus block (SCPB) for anesthesia in the creation of AVF in the medial side of the arm. Methods: This randomized, double-blind trial was carried out on 75 patients, 18 - 65 years old, both sexes undergoing creation AVF in the medial side of the arm. Participants were randomized equally into three groups receiving SCPB, followed by traditional landmark ICBN (TICBN) in group T, US-guided ICBN in group U, or US-guided SPB in group S. Results: Groups U and S needed less local anesthesia supplementation than group T (8%, 12%, 44%, P < 0.05). Time for first rescue analgesia was delayed in U and S as opposed to T, and in U as opposed to S (P < 0.001). Fentanyl consumption was diminished in U and S than T, and in U than S (P < 0.001). Visual Analogue Scale scores were diminished in U and S as opposed to T at 2 and 4 hours, with no difference between U and S; at 8 hours, T and U had diminished VAS than S (P < 0.05). Patient satisfaction was better in the U than in the T and S (P = 0.002). Conclusions: US guided ICBN and SPB provide superior anesthesia and postoperative analgesia as opposed to TICBN following the creation of AVF in the arm medial side.