# 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

## TL;DR

This study compares ultrasound-guided and landmark-guided nerve blocks for pain management after a specific type of arm surgery, finding that ultrasound guidance provides better results.

## Contribution

The study introduces a comparison of ultrasound-guided techniques versus traditional landmark methods for nerve blocks in AV fistula surgery.

## Key findings

- Groups using ultrasound guidance required less local anesthesia supplementation than the landmark group.
- Ultrasound-guided groups experienced delayed need for rescue analgesia and reduced fentanyl consumption.
- Patient satisfaction was higher in the ultrasound-guided group compared to the other two groups.

## Abstract

Effective postoperative pain management is necessary to enhance patient recovery and satisfaction following the creation of an arteriovenous fistula (AVF).

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.

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.

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).

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.