Ultrasound-Guided Pectoral Nerves Block Type II or Intercostobrachial Nerve Block as A Supplement to Supraclavicular Block in End-Stage Renal Disease Patients’ Arteriovenous Access: A Randomized Controlled Trial

Background: Intercostobrachial nerve (ICBN) innervates the upper half of the medial aspect of the arm and axilla. We hypothesized to assessing either pectoral nerves block type II (PECS II) or ICBN block would improve the quality of block for proximal arm arteriovenous access surgery.
Materials and Methods: In the study, forty adult patients with the end-stage renal disease aged between 18 and 70 years received a combined supraclavicular block with 30 ml 0.25% bupivacaine, and either ICBN (Group A, n = 20) or PECS II block with 10 ml 0.25% bupivacaine (Group B, n = 20) for proximal arm arteriovenous access surgery. The primary outcome was whether patients required intraoperative local anesthetic supplementation. Secondary outcomes were the volume of local anesthetic supplementation, fentanyl administration, Pain scores 24 hours postoperatively, and time to first postoperative rescue analgesia.
Results: Local anesthetic (LA) supplementation was required in 4 patients in group A and 6 patients in group B, and the mean volume of LA was lower in group A than group B as the complete sensory block in the medial side of the upper arm was achieved in 80% of patients in group A and 70 % in group B. There was a statistically significant decrease in time taken for blocks in group B (PECS) compared to group A and, the insignificant difference between the two studied groups regarding fentanyl received and time to 1st postoperative rescue analgesia.
Conclusion: ICBN and PECS blocks are ideal supplements to supraclavicular brachial (SCB) with statistically insignificant fewer patients in ICBN required LA volume and supplementation than PECS II block.