Korean J Anesthesiol.  2025 Jun;78(3):279-284. 10.4097/kja.24893.

Axillary serratus anterior plane block as a novel approach to anesthetizing the intercostobrachial nerve for upper arm arteriovenous fistula creation surgery -three case reports-

• Chan CH
• Lim JY
• Mathews AM

• KMID: 2568216
• DOI: http://doi.org/10.4097/kja.24893

Abstract

Background
Current regional anesthesia techniques used to anesthetize the intercostobrachial nerve (ICBN) for upper arm surgery either lack reliability or have increased procedural risks. Safer and more reliable regional anesthetic techniques are required to block the ICBN effectively. Here, we introduce a novel “axillary serratus anterior plane (A-SAP) block” for anesthetizing the ICBN to allow surgical anesthesia for upper arm arteriovenous fistula (UA-AVF) creation. Case: We present 3 cases involving a 79-year-old Chinese male, a 73-year-old Malay female, and a 38-year-old Chinese male, in which the A-SAP block was utilized in UA-AVF creation surgeries. In all 3 cases, the A-SAP block was performed in combination with a supraclavicular brachial plexus block. None of the patients required local anesthetic supplementation intraoperatively.
Conclusions
The A-SAP block reliably and safely anesthetized the ICBN for UA-AVF creation surgery and is a reliable alternative to higher-risk block techniques, such as paravertebral block or neuraxial block.

Keyword

Anesthesia, conduction; Arteriovenous fistula; Axilla; Nerve block; Renal dialysis; Surgical procedures, operative