# Ultrasound-guided supraclavicular brachial plexus block as an additive to sevoflurane anesthesia in pediatrics undergoing brachiobasilic arteriovenous fistula operation: randomized controlled clinical trial

## TL;DR

This study shows that adding an ultrasound-guided nerve block to general anesthesia improves outcomes in children with kidney disease undergoing a specific surgery.

## Contribution

The study demonstrates the safety and efficacy of ultrasound-guided brachial plexus block as an anesthetic adjuvant in pediatric renal patients.

## Key findings

- The block group had shorter fistula maturation time and lower primary failure rates.
- The block group showed better pain control and hemodynamic stability during surgery.
- Anesthesia consumption was reduced in the block group.

## Abstract

Renal disease is a significant cause of morbidity and mortality in children and is uniquely challenging in the anesthetic management of pediatric patients. Perioperative pain management is a core component in the anesthetic plan. Pediatric regional anesthesia is one of the most valuable and safe tools to treat perioperative pain.

Sixty pediatric patients with chronic kidney disease scheduled for upper limb superficialization of brachiobasilic arteriovenous fistula to facilitate hemodialysis completed the study. Patients were randomly allocated into two groups; the block group received combined general anesthesia plus ultrasound-guided supraclavicular block, and the control group received general anesthesia only.

The block group recorded a significantly lower fistula maturation duration, more dilatation in basilic vein diameter, lower primary failure rate, postoperative VAS scores, anesthesia consumption, better RASS scores and longer analgesia duration. Moreover, the block group showed more stable hemodynamics with less reduction in MAP than the control group.

Ultrasound-guided supraclavicular brachial plexus block is a safe and feasible adjuvant to general anesthesia that could reduce brachiobasilic AVF maturation time, primary failure rate, control perioperative operative pain and improve the quality of anesthesia recovery by reducing emergence agitation and minimizing sevoflurane anesthesia consumption in pediatric patients with end-stage renal disease.

The study was registered on clinical trial registration (NCT05580094) in October 2022.

1. Ultrasound-guided nerve brachial plexus block is a safe and effective anesthetic adjuvant in pediatric anesthesia.

2. It provides robust intraoperative hemodynamic stability in pediatric patients with ESRD.

3. It might play an adjuvant role in enhancing AVF maturation.