Ultrasound-Guided Axillary Brachial Plexus Block in Patients with End-Stage Kidney Disease at Brazzaville University Teaching Hospital

Aim : to describe the anaesthetic management of patients with End-Stage Kidney Disease (ESKD) undergoing surgical procedures to create Arterio-Veinous Fistula (AVF) under ultrasound-guided Axillary Brachial Plexus Block (ABPB) in a campaign offering free AVF creation at Brazzaville University Teaching Hospital (CHUB). Patients and methods : The study was a descriptive, cross-sectional, single-centre study conducted from 1st to 18th July 2025 in the operating room at the CHUB. After obtaining their written consent, we had included patients with ESKD underwent AVF creation under ultrasound-guided ABPB in a free treatment programme. The variables socio-epidemiological, related to ESKD, related to haemodialysis, clinical, biological, therapeutic, related to ABPB and related to the AVF were studied Microsoft Excel 2021. Results : 40 patients were involved. The median age was 48 years [41-63 years]. The sex ratio was 3: 1, and 37.5% of patients had no source of income. ESKD had been diagnosed for a median of 6 months [3-12 months]. Haemodialysis (95%) was carried out using a femoral catheter (52.6%) and 80% of patients (n=32) had three sessions per week. Comorbidities (100%) were dominated by hypertension (97.5%). Long-term treatment (92.5%) combined an antihypertensive medication (97.3%) in a dual-therapy (41.7%) with amlodipine (69.2%). In anaesthesia consultation, an imbalance in arterial pressures (57.5%), a normal clinical examination (42.5%) and ASA 3 (100%) were predominant. The median duration of the ultrasound-guided ABPB was 11 minutes [10-12 minutes]. The procedure took between 11 and 15 minutes for 52.5% of patients. Bupivacaine 2 mg/ml (100%) was used with a median volume injected of 22 ml [20-25 ml] (range: 15-32 ml) and in 50% of cases, the volume injected was between 10 and 20 ml. The median time to onset of sensory block was 3 minutes [3-5 minutes] and in 87.5% of cases the time to onset was less than five minutes. Motor block was complete in all patients (100%). All ABPB procedures were ‘successful’ (100%). No intraoperative anaesthetic complications were recorded. The sensory block had a median duration of 250 minutes [217.5-280 minutes]. The AVFs were proximal (75%). The median duration of AVF surgery was 135 minutes [80-180 minutes] with 95% of success. All patients (100%) were transferred to POCU following surgery. Conclusion : Ultrasound-guided ABPB enabled the surgical creation of AVF in 40 patients with ESKD at the CHUB. The success rate for ABPB was 100% and that for AVF was 95%.