Comparison Between Ultrasound-guided Intercostobrachial Nerve Block with Supraclavicular Block versus Ultrasound -guided Erector Spinae block with Supraclavicular Block for Medial Arm A-V Fistula Surgery
ESRD patient undergoing creation AVF in the medial side of the arm.
1. Patient refusal 2. Drug allergies 3. Body Mass Index of 35 kg/m² or more 4. Coagulation abnormalities 5. Severe heart, kidney, and liver diseases, 6. Pregnancy 7. Vasculitis 8. Unstable hemodynamics 9. Upper extremity neuropathy 10. Mental illness 11. Seizures 12. Contralateral chest problems 13. Infection at site of injection
Parallel
intercostobrachial nerve block
Procedure/Surgerythe intercostobrachial nerve will be blocked using Ultrasound-Guided Procedure after SCPB, the ICBN was blocked under US guidance at the mid-axillary level. The patient was positioned supine with the arm abducted to 90°. A high-frequency linear probe will be placed transversely over the mid-axillary line at the level of the 2nd-3rd intercostal spaces. The axillary vein and artery were first visualized, then the probe was adjusted superficially to identify the fascial plane between the subcutaneous tissue and the serratus anterior muscle. The ICBN appeared as a small hyperechoic oval or linear structure within this plane. Using an in-plane, posterio-anterior needle approach, an 80-mm block needle was advanced into the fascial plane. After confirming negative aspiration, 10 ml of the same local anesthetic mixture was administered (0.5% bupivacaine and 2% lidocaine)
ultrasound-guided erector spinae plane block
Procedure/Surgerypatient will be placed in a lateral decubitus with the operation site up and we will count the vertebrae from cephalad to caudal direction until we reach T2 spinous process as the first palpable spinous process is C7. Ultrasound probe will be placed vertically 3 cm lateral to the T2 spinous process. linear transducer was placed on the superior-posterior aspect of the operation site shoulder close to the neck to observe the short axis view of the transverse processes of T2 and T3. The same type of block needle was inserted and advanced in a caudad-to-cephalad direction toward the space between the two transverse processes using in-plane ultrasound guidance. Immediately after penetrating the anterior fascia of the erector spinae muscles, 10 ml of the same local anesthetic mixture was administered
achievement of complete sensory block
pinprick test showed that the entire upper arm and lateral aspect of the left upper chest wall are anesthetized
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