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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims 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 reliable surgical anesthesia for upper arm arteriovenous fistula (UA-AVF) creation.Methods We present three cases in which the A-SAP block and supraclavicular brachial plexus block was utilized in UA-AVF creation surgeries. The A-SAP block was administered with the patients in the supine position, ipsilateral shoulder abducted 90°, and externally rotated. A linear 15–4-MHz ultrasound transducer was placed at the mid-clavicular line immediately caudal to the clavicle and the 2nd rib was identified. The probe was slid caudally to the 3rd rib, and then laterally towards the anterior axillary line, while keeping the 2nd intercostal space in view. The caudal end of the ultrasound probe was then rotated laterally, with the cranial end pivoting on the 2nd rib to obtain a transverse orientation. The pectoralis major, pectoralis minor, serratus anterior, intercostal muscles, 2nd and 3rd rib, pleura, and the axillary compartment could be seen in this view. The block needle was inserted medial to the ultrasound transducer and was directed laterally using an in-plane approach to reach the fascial plane between the pectoralis minor and serratus anterior muscles. The fascial plane was hydrodissected towards the axillary compartment, lifting it off the serratus anterior muscle, where the local anesthetic was then deposited.Results In all three cases, none of the patients required local anesthetic supplementation intraoperatively.Abstract P174 Figure 1Illustration of the ultrasound probe position for the axillary serratus anterior plane (A-SAP) block. A linear 15–4 MHz ultrasound transducer was placed between the 2nd and the 3rd rib, between the mid-clavicular line and anterior axillary line, in a transverse positionAbstract P174 Figure 2A typical ultrasound image obtained while administering the axillary serratus anterior plane (A-SAP) block. The pectoralis major muscle, pectoralis minor muscle, serratus anterior muscle, 2nd rib, 3rd rib, intercostal muscles, pleura, and the axillary compartment is labelledConclusions In this case series, we introduced the A-SAP block as a reliable technique for anesthetizing the ICBN, providing effective surgical anesthesia for UA-AVF creation.