Ultrasound-Guided T2 Erector Spinae Plane Block Versus Intercostobrachial Block in AV Fistula Surgery.

Arteriovenous fistula (AVF) superficialization is an essential procedure for patients with end-stage renal disease . The supraclavicular brachial plexus block is commonly used for upper extremity surgeries .Because the ICBN originates from the T2 nerve root below the C5-T1 nerve roots comprising the brachial plexus, brachial plexus blocks are ideally supplemented with an ICBN infiltration block for medial upper arm coverage.The ICBB requires precise ultrasound guidance to target the ICBN, which is small and variably located, making it technically challenging and time-intensive.

ESP block at T2 level can provide broad coverage, ease of Performance, superficial injection and requiring less technical expertise compared to the ICBB .

The patients are randomly allocated into 2 groups :

• Erector spinae plane block group (Group ESP): will receive 10 ml of 0.5% bupivacaine injected into the erector spinae plane at T2 level under ultrasound guidance.
• Intercostobrachial block group (Group ICBB): will receive 10 ml of 0.5% bupivacaine injected around intercostobrachial nerve under ultrasound guidance. • Standard Supraclavicular Brachial plexus Block will be performed for all patients using 20 ml of 0.5% bupivacaine under ultrasound guidance.

Inclusion criteria

• • Adults scheduled for upper extremity surgeries under regional anesthesia.

• Age: 18-65 years.
• American society of Anesthesiologists (ASA) III.
• Body Mass Index (BMI) < 35 kg/m².

Exclusion criteria

• •Allergy to local anesthetics.

• Coagulopathy or infection at injection sites.
• Pre-existing neuropathy or significant psychiatric disorders.
• Pregnant or lactating women.