الفهرس 
ESRD patientsOnly 14 pages are availabe for public view
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Abstract
End stage renal disease (ESRD) is a Stage 5 of chronic kidney disease (CKD) at which GFR <15 mL/min/1.73 m2 and requiring dialysis(15,16). Dialysis-dependent patients commonly require surgery for reasons related to ESRD, including vascular access procedures (arteriovenous fistula (AVF)), parathyroidectomy or renal transplantation.
ESRD patients are known to be at increased risk for perioperative and post-operative complications(2), especially with general anesthesia (GA) as it is associated with increased cardiorespiratory complications(3). Therefore, Regional anesthesia (RA) is considered the safer and preferred option as it avoids significant risks associated with GA in these patients(4,5).
Furthermore, only RA produces an associated sympathetic nerve block which results in an increased venous diameter and vessel flow, intra-operatively and for several hours post-operatively(6,7). This can help to prevent thrombosis, early fistula failure and is important for fistula maturation(8).
Brachial plexus block (BPB) is often utilized for proximal arm arteriovenous access creation. However, the medial upper arm and axilla are often inadequately anesthetised, as 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, intraoperative local anesthetic (LA) supplementation up to conversion into GA(9).
The Intercostobrachial nerve (ICBN) can be blocked together with other nerves, such as the pectoral, intercostal, and long thora