Ultrasound-Guided Supraclavicular Brachial Plexus Block for Analgesia during Endovascular Treatment of Dysfunctional Hemodialysis Fistulas

Ultrasound-Guided Block of Selective Branches of the Brachial Plexus for Vascular Access Surgery in the Forearm: A Preliminary Report

“…The MACN (1) runs adjacent to the BaV, passes deeply through the brachial fascia and past the junction of the BaV and BV, tracks proximally along the BV and is positioned in the median superficial side of the axilla over the neurovascular bundle. The ulnar nerve (2) runs upward from the medial side to near the BA and is positioned at the anteromedial side of the BA in the bundle at the axilla. The radial nerve (3) runs parallel to the deep BA along the inner side of the LoHTBM proximally and is located at the posteromedial site of the BA just above the TLDM at the axilla.…”

“…Ideally, it provides effective anesthesia and adequate analgesia with an appropriate duration of action. US-guided BPB is used in patients undergoing arteriovenous graft (AVG) implantation and those undergoing surgeries requiring a wide incision, such as removal of an infected graft, as well as for procedures that use an above-elbow tourniquet for hemostatic control of high-flow fistulas and for percutaneous transluminal angioplasty for refractory strictures (1, 2). An axillary approach to BPB provides a suitable extent of anesthesia for surgical and percutaneous VA procedures in the forearm while limiting the risks of pneumothorax and phrenic nerve paresis that are associated with infra- and supraclavicular approaches (3).…”

Durability of the Viabahn stent graft after axillary artery pseudoaneurysm exclusion

“…Although such a practice is considered routine and safe in the hands of experienced practitioners, numerous randomized studies have demonstrated ultrasound-guided visualization clearly enhances the safety profile of needle placement and provides accurate anesthetic administration compared with anesthetic procedures performed without ultrasound guidance. 19 , 20 A similar safety benefit of ultrasound-guided femoral artery access has been demonstrated in endovascular interventions, with significantly reduced procedural related complications. 21 Given the increased adaptation of endovascular procedures in the past decade, portable ultrasound equipment is now commonly found in many operating rooms.…”

Ultrasound in dialysis access: Opportunities and challenges

“…In a prospective study of 40 consecutive patients, brachial plexus blockade using a supraclavicular approach under US guidance resulted in 100% technical success in achieving both sensory and motor analgesia. 25…”