Supraclavicular Plexus Block Procedure (SCPB)NCT07852351
Ultrasound Guidance Intercostobrachial Nerve Block in AVF Superficialization
A study testing Distal Intercostobrachial Nerve Block and Supraclavicular Plexus Block Procedure (SCPB) in people with Supraclavicular Plexus Block Procedure (SCPB) and ESRD, run by Assiut University.
Trial summary
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 Read more about this study
- Who is it for?
- Ages 18 to 60 years
- Conditions the study is for
- Supraclavicular Plexus Block Procedure (SCPB), ESRD
- What is being tested?
- Distal Intercostobrachial Nerve Block and Supraclavicular Plexus Block Procedure (SCPB)
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 76 participants
- Where
- No sites listed yet
- Study dates
- 1 Oct 2026to 1 Mar 2028
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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)
Who cannot join
- 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.
About this study
Official title: 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
Read the 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.
- Being tested
- Distal Intercostobrachial Nerve Block, Supraclavicular Plexus Block Procedure (SCPB)
- Keywords
- esrd, Supraclavicular Plexus Block Procedure (SCPB)
- Medical subject headings
- Kidney Failure, Chronic
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Distal Intercostobrachial Nerve BlockProcedure or surgery
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
Supraclavicular Plexus Block Procedure (SCPB)Procedure or surgery
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
| Study group | Role | What they receive |
|---|---|---|
| Distal Intercostobrachial Nerve Block with large vloume | Experimental | Distal Intercostobrachial Nerve Block will be conducted with 12 millimeters of Bupivacaine 0.25%. Receives: Procedure: Supraclavicular Plexus Block Procedure (SCPB) |
| Distal Intercostobrachial Nerve Block with small vloume | Experimental | Distal Intercostobrachial Nerve Block will be conducted with 6 millimeters of Bupivacaine 0.25 % Receives: Procedure: Distal Intercostobrachial Nerve Block |
What is being measured
The primary outcome is the main question the study is designed to answer.
Comparing the incidence of successful complete sensory block
successful complete sensory block between the two techniques at 30 minutes after injection using cold sensitivity test.
Measured: baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Oct 2026
- Study start1 Oct 2026 (estimated)
- Primary completion1 Dec 2027 (estimated)
- Study completion1 Mar 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Supraclavicular Plexus Block Procedure (SCPB)Studies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 76 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ahmed Mahmood Ahmed Mohammed, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07852351
- Sponsor's protocol ID
- AVF2026
- Status last verified
- Oct 2026
- First submitted
- 24 Sep 2026
- Last updated
- 7 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 7 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Two Different Volumes of Ultrasound-Guided Distal Intercostobrachial Nerve Block on Block Success During Arteriovenous Fistula Superficialization Surgery
- ClinicalTrials.gov ID
- NCT07852351
- Acronym / sponsor ID
- AVF2026
- Keywords
- esrd, Supraclavicular Plexus Block Procedure (SCPB)
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 76 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 1 Oct 2026 (estimated)
- Primary completion
- 1 Dec 2027 (estimated)
- Study completion
- 1 Mar 2028 (estimated)
- First posted
- 1 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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
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 design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Distal Intercostobrachial Nerve Block with large vloume | Experimental | Procedure: Supraclavicular Plexus Block Procedure (SCPB)Distal Intercostobrachial Nerve Block will be conducted with 12 millimeters of Bupivacaine 0.25%. |
| Distal Intercostobrachial Nerve Block with small vloume | Experimental | Procedure: Distal Intercostobrachial Nerve BlockDistal Intercostobrachial Nerve Block will be conducted with 6 millimeters of Bupivacaine 0.25 % |
Who may qualify
- Ages
- 18 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- 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)
Key exclusion criteria (6 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Distal Intercostobrachial Nerve BlockUltrasound 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 | Procedure or surgery | Distal Intercostobrachial Nerve Block with small vloume |
| 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 | Procedure or surgery | Distal Intercostobrachial Nerve Block with large vloume |
Primary outcome
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.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Oct 2026.
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing Distal Intercostobrachial Nerve Block and Supraclavicular Plexus Block Procedure (SCPB) in people with Supraclavicular Plexus Block Procedure (SCPB) and ESRD, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 7 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Comparing the incidence of successful complete sensory block (time frame: baseline). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2026.