Document resource
Background and Aims Arteriovenous (A-V) fistula formation is the gold standard for dialysis access in adults, with benefits demonstrated in children as well. Regional anesthesia (RA) in adults provides superior analgesia, enhanced primary fistula patency, and the possibility of intraoperative spontaneous breathing. Brachial plexus blocks (BPB) are the most common RA modality, with the axillary BPB widely regarded as the primary option.Methods We retrospectively analyzed patient data at the University Children’s Hospital in Belgrade, from January 1st 2022 to December 31st 2024. Ten patients underwent antebrachial A-V fistula formation under procedural sedation and ultrasound guided axillary BPB. On induction patients received Fentanyl and Propofol, while sedation was maintained with continuous Propofol. All patients received an axillary BPB using 1–2% Lidocaine (2,52 ± 0,88 mg/kg) and 0,5% Levobupivacaine (1,49 ±0,4 mg/kg). Local ethics committee approval was obtained.Results Patients were breathing spontaneously, maintaining hemodynamic and respiratory stability. No additional intra/postoperative opioids were given, with total opioid consumption limited to an average of 1.56 mcg/kg on induction. Postoperative analgesia was satisfactory, with first NSAID administration after 14±4 hours.Abstract EP196 Figure 1Ultrasound imaging and needle trajectoryAbstract EP196 Figure 2Local anaesthetic doseConclusions Axillary BPB is a safe and effective method for managing antebrachial A-V fistula formation in children. We can eliminate the use, and associated risks of general anesthesia entirely, with the additional positive effect on the fistula itself. This proposes RA as a primary option, especially when present comorbidities enhance the risk of general anesthesia and attempted endotracheal intubation, highlighting the benefit of spontaneous breathing. RA also enables surgical planning for fistula instead of graft, thereby ensuring preferred hemodialysis access.