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Background <p>Balloon angioplasty for forearm arteriovenous fistula (AVF) often provokes substantial pain during inflation.</p> Objective <p>To compare an ultrasound-guided suprafascial plane block (SFPB) with brachial plexus block (BPB) during forearm AVF percutaneous transluminal angioplasty (PTA), focusing on analgesic effectiveness and safety.</p> Methods <p>Single-center, retrospective comparative study (January 1–December 31, 2025) of consecutive adults with forearm radiocephalic AVFs. SFPB targeted the superficial fascia–deep adipose tissue (SF–DAT) interface after sheath placement and guidewire traversal; BPB was completed before venipuncture. The primary endpoint was peak-inflation pain on the numeric rating scale (NRS, 0–10). Secondary outcomes included rescue analgesia, procedure time, block-related complications, and short-term patency.</p> Results <p>We analyzed SFPB (<i>n</i> = 32) and BPB (<i>n</i> = 35). The primary endpoint favored BPB (mean peak-inflation NRS 1.54 ± 0.74 vs. 2.66 ± 0.85; mean difference − 1.12, 95% CI − 1.51 to − 0.73; <i>p</i> = 0.0038). Importantly, SFPB achieved the prespecified analgesic adequacy threshold (NRS ≤ 3) in 87.5% of patients (28/32) with no rescue analgesia, no conversion, and no transient motor block. By contrast, BPB caused universal transient motor block and hoarseness in 2 patients. Procedure time was similar between groups (70.77 ± 37.51 vs. 87.49 ± 36.21&#xa0;min; <i>p</i> = 0.0613). One- and three-month primary patency was 100% in both groups.</p> Conclusions <p>This retrospective study shows that SFPB provides clinically adequate, motor-sparing analgesia suitable for outpatient forearm AVF–PTA, while BPB yields better pain control but causes universal transient motor block. SFPB may be considered a pragmatic, image-standardizable option for selected patients. These findings are preliminary; prospective trials are needed to confirm efficacy and safety.</p>

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Ultrasound-guided suprafascial plane block for forearm AVF angioplasty: a motor-sparing, image-standardizable alternative to brachial plexus block in a single-center retrospective comparison

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  • 发表日期：

    2026年6月23日

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  • Wenshen Pu,
  • Limei Dong,
  • Zhican He,
  • Zhihu Chen,
  • Bingjie Wang,
  • Zhangjian Xu,
  • Yi Zhang,
  • Bo Hu,
  • Ziming Wan

摘要

Background

Balloon angioplasty for forearm arteriovenous fistula (AVF) often provokes substantial pain during inflation.

Objective

To compare an ultrasound-guided suprafascial plane block (SFPB) with brachial plexus block (BPB) during forearm AVF percutaneous transluminal angioplasty (PTA), focusing on analgesic effectiveness and safety.

Methods

Single-center, retrospective comparative study (January 1–December 31, 2025) of consecutive adults with forearm radiocephalic AVFs. SFPB targeted the superficial fascia–deep adipose tissue (SF–DAT) interface after sheath placement and guidewire traversal; BPB was completed before venipuncture. The primary endpoint was peak-inflation pain on the numeric rating scale (NRS, 0–10). Secondary outcomes included rescue analgesia, procedure time, block-related complications, and short-term patency.

Results

We analyzed SFPB (n = 32) and BPB (n = 35). The primary endpoint favored BPB (mean peak-inflation NRS 1.54 ± 0.74 vs. 2.66 ± 0.85; mean difference − 1.12, 95% CI − 1.51 to − 0.73; p = 0.0038). Importantly, SFPB achieved the prespecified analgesic adequacy threshold (NRS ≤ 3) in 87.5% of patients (28/32) with no rescue analgesia, no conversion, and no transient motor block. By contrast, BPB caused universal transient motor block and hoarseness in 2 patients. Procedure time was similar between groups (70.77 ± 37.51 vs. 87.49 ± 36.21 min; p = 0.0613). One- and three-month primary patency was 100% in both groups.

Conclusions

This retrospective study shows that SFPB provides clinically adequate, motor-sparing analgesia suitable for outpatient forearm AVF–PTA, while BPB yields better pain control but causes universal transient motor block. SFPB may be considered a pragmatic, image-standardizable option for selected patients. These findings are preliminary; prospective trials are needed to confirm efficacy and safety.