Ultrasound Guidance Intercostobrachial Nerve Block in AVF Superficialization

October 3, 2026 updated by: Ahmed Mahmood Ahmed Mohammed, Assiut University

Effect of Two Different Volumes of Ultrasound-Guided Distal Intercostobrachial Nerve Block on Block Success During Arteriovenous Fistula Superficialization Surgery

The present clinical study will be undertaken to evaluate and compare the clinical efficacy of two different volumes of distal ICBN block when combined with a baseline supraclavicular brachial plexus block during superficialization of upper arm arteriovenous fistula

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Patients with chronic renal failure, particularly those with end-stage kidney disease, usually have multiple co-morbid conditions, and thus, regional anesthesia is usually preferred over general anesthesia (GA) in such cases Arteriovenous fistula (AVF) superficialization is a critical surgical procedure commonly performed in patients with end-stage renal disease to facilitate adequate hemodialysis access Ultrasound-guided brachial plexus block provides excellent surgical anesthesia for upper extremity procedures and is widely used during (AVF) creation. However, superficialization of the fistula often requires an extended incision and deeper dissection along the medial aspect of the arm. Because the intercostobrachial nerve (ICBN) originates from the second intercostal nerve (T2) rather than the brachial plexus, brachial plexus block alone does not provide reliable anesthesia of the axilla and upper medial arm supplied by the ICBN The skin and subcutaneous tissue in this specific region are heavily innervated by the ICBN, which originates as the lateral cutaneous branch of the second intercostal nerve (T2) and bypasses the brachial plexus entirely. Consequently, brachial plexus alone may not provide adequate anesthesia of the medial upper arm. So patients undergoing this procedure often experience sharp and intense intraoperative pain during medial skin tunneling and surgical manipulation if the ICBN is not separately anesthetized To address this anatomical challenge, ICBN block must be performed in conjunction with the primary brachial plexus blockade. Traditionally, a conventional landmark-guided subcutaneous infiltration has been used to block the ICBN as it emerges into the axillary fossa. However, this blind technique exhibits variable success rates and carries a risk of incomplete sensory coverage, and can lead to accidental vascular puncture in the highly vascular axillary region (Magazzeni et al., 2018). With the advancement of regional anesthesia, ultrasound-guided fascial plane blocks several approaches have been described, including , ultrasound-guided distal block, proximal block at the chest wall, and fascial plane techniques, with variable success rates reported among studies. One possible explanation for these inconsistent results is the considerable anatomical variability of the ICBN. Cadaveric studies have demonstrated variations in its origin, branching pattern, and communications with adjacent nerves. Furthermore, approximately one-third of ICBNs may receive contributions from neighboring intercostal nerves, potentially limiting the effectiveness of localized distal injections.In a randomized trial, Moustafa and Kandeel reported a complete sensory block success rate of only 51% using a distal ultrasound-guided ICBN block with 6 mL of local anesthetic, suggesting that distal blockade may not reliably anesthetize all relevant nerve branches. Given the considerable anatomical variability of the ICBN and its terminal branches, the extent of local anesthetic spread may influence the success of distal ICBN blockade. It is therefore plausible that larger injectate volumes may improve neural coverage and increase the probability of achieving complete sensory blockade. This hypothesis has not been specifically evaluated in previous clinical studies.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
76

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult patients aged 18 to 65 years of either sex
  • Patients scheduled for elective upper-arm AVF superficialization (brachiobasilic or brachiocephalic)
  • ASA physical status II, III (common in chronic kidney disease patients)

Exclusion criteria:

  • Pre-existing peripheral neuropathy or severe neurological deficits in the operative upper extremity.
  • Cognitive impairment, psychiatric disorders, or an inability to comprehend and communicate the pain scoring scales
  • Patients on chronic opioid use
  • Local infection, severe dermatitis, or anatomical distortions at the proposed needle insertion sites.
  • Known allergy or hypersensitivity to local anesthetics.
  • Patient refusal of regional anesthesia techniques.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Distal Intercostobrachial Nerve Block with large vloume

Distal Intercostobrachial Nerve Block will be conducted with 12 millimeters of Bupivacaine 0.25%.
Procedure: Supraclavicular Plexus Block Procedure (SCPB)

supine with the head turned approximately 30° away from the surgical side, and a small towel will be positioned between the scapulae to optimize access. After aseptic preparation, a high-frequency linear US probe (6 - 12 MHz) covered with a sterile sheath will be placed in the coronal-oblique plane just superior to the clavicle and lateral to the sternocleidomastoid muscle to visualize the subclavian artery medially, the brachial plexus divisions as a cluster of hypoechoic round structures lateral to the artery, and the first rib and pleura as hyperechoic lines deep to the artery. Using an in-plane lateral-to-medial approach, a 22-G, 80-mm insulated block needle will be advanced under continuous US guidance toward the "corner pocket" bordered by the subclavian artery medially, the first rib inferiorly, and the brachial plexus laterally. After negative aspiration, Ten mL of bupivacaine 0.3% will be injected into the corner pocket. needle will be redirected to deposit additional 3 - 5 mL
Experimental: Distal Intercostobrachial Nerve Block with small vloume

Distal Intercostobrachial Nerve Block will be conducted with 6 millimeters of Bupivacaine 0.25 %
Procedure: Distal Intercostobrachial Nerve Block

Ultrasound Positioning and Administration: The transducer will be placed transversely across the inner aspect of the arm, directly beneath where the pectoralis major muscle attaches.

Infiltration Technique: Probe transversely across the axillary fold/proximal medial arm.

Identify pectoralis major anteriorly and latissimus dorsi posteriorly. The target is the subcutaneous plane superficial to the brachial fascia, spanning between these muscular boundaries.

Patients will be divided into two equal groups. Group H will be injected with 12 milliliters of bupivacaine 0.25%, and Group L will be injected with 6 milliliters of bupivacaine 0.25%, while advancing the needle so the LA forms a continuous subcutaneous spread from the pectoralis major side toward the latissimus dorsi side

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Comparing the incidence of successful complete sensory block
Time Frame: baseline

successful complete sensory block between the two techniques at 30 minutes after injection using cold sensitivity test.
baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Assiut University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
March 1, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 24, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 30, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 1, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 7, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 3, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AVF2026

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

Yes

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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