Brachial plexus block (BPB) is often utilized for proximal arm arteriovenous access creation. However, the medial upper arm and axilla are often inadequately anesthetized, as the Intercostobrachial nerve (which provides sensory supply to the axilla, upper medial arm, and a small area at the upper lateral chest) is not a component of the brachial plexus. This requires repeated, an intraoperative local anesthetic (LA) supplementation up to conversion into GA. The intercostobrachial nerve (ICBN) is a purely sensory nerve that arises primarily from the second intercostal nerve (T2) with occasional contribution from T3. Therefore, It is not a component of the brachial plexus and is not anesthetized by brachial plexus blockade. The ICBN can be blocked together with other nerves, such as the pectoral, intercostal, and long thoracic nerves in a recently described technique named pectoral nerves block type II (PECS II ).In this thesis, investigators compared the use of the PECS II block and ICBN block as a supplement to supraclavicular brachial plexus block for providing complete anesthesia of the upper arm for fistula creation surgery.

Inclusion Criteria:

• ESRD patients.
• Proximal Arm Arteriovenous Access Surgery.
• Elective or emergency surgery
• American Society of Anesthesiology (ASA) physical status II to III.

Exclusion Criteria:

• Inability of the patient to provide informed consent, communicate or cooperate
• History of allergy to local anesthetics.
• Preexisting upper limb neurological disease at the side of the surgery.
• Patients on anticoagulant therapy or with history of coagulopathy.
• Previous surgery at or near the site of the study.
• The presence of skin infection at the puncture site.

IPD will be available after end of the study

for 1 year after the end of the study

study protocol